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PubMed1990

[Rapid resolution of acute subdural hematoma. Report of two cases].

The authors report two cases of rapid resolution of acute subdural hematoma. Case 1, a 78-year-old male, sustained head trauma and became unconscious for a few minutes, but on arrival he was alert and neurological examination was normal. A computed tomography (CT) scan taken 5 hours after the injury showed a high-dense subdural hematoma partly containing low-density area over the right cerebral hemisphere. He was conservatively treated. A CT scan taken 33 hours after the injury disclosed diminution of the hematoma and appearance of a thin high-density layer in the subdural space adjacent to the tentorium. The high-density layer disappeared on a CT scan taken 7 days after the injury. Case 2, an 84-year-old female, struck her head in the occipital region. On arrival she was drowsy but otherwise had no neurological abnormality. A CT scan taken 1 hour after the injury demonstrated a high-dense subdural hematoma partly containing low-density area over the right cerebral hemisphere. She was conservatively managed and became asymptomatic. A CT scan taken 14 hours after the injury disclosed complete resolution of the hematoma and appearance of a thin high-density layer in the subdural space adjacent to the falx and the tentorium. This high-density layer also completely disappeared on a CT scan taken 14 days after the injury. It was suggested that a mechanism of rapid resolution of the acute subdural hematoma was attributable to washing-out by cerebrospinal fluid.

Acute Disease↗
PubMed1996

Ultrastructure of the human spinal arachnoid mater and dura mater.

Human spinal dura and arachnoid, obtained during neurosurgical operations, were studied by transmission electron microscopy. The ultrastructure of spinal meninges largely conformed to the morphology of the cranial meninges, but some minor differences were detected. The dura was composed of an outermost loosely arranged fibroelastic layer, a middle basically fibrous portion and an innermost cellular layer (dural border cell layer). The dural border cell layer was characterised by multiple interdigitating cell processes, no extracellular collagen, significant extracellular spaces and few cell junctions. Paravascular vesiculated nerve profiles were encountered within the fibroadipose epidural tissue. The arachnoid was composed of an outermost portion (arachnoid barrier cell layer), presenting tightly packed cells, numerous tight junctions and no extracellular collagen. In view of its numerous tight junctions, the arachnoid barrier cell layer is considered to represent an effective morphological and physiological meningeal barrier between the cerebrospinal fluid in the subarachnoid space and the blood circulation in the dura. The arachnoid barrier layer was always characterised by a distinct continuous basal lamina on its inner surface towards the innermost collagenous portion of the arachnoid (arachnoid reticular cell layer). The interweaving arachnoid trabecular cells within this layer possessed numerous mitochondria and were anchored to the inner surface of the arachnoid barrier cell layer by desmosomes. An additional layer of flattened branching cells was demonstrated along the inner surface of the arachnoid reticular cell layer and assumed to be an "arachnoid border cell layer'. Morphological data suggest that the dura and arachnoid closely adhere at spinal levels in man without any naturally occurring "subdural space'. However, structurally, the dural border cell layer forms a weak cell layer at the dura-arachnoid continuum that is easily disrupted. The creation of an artifactual subdural space at spinal levels is discussed.

Adolescent↗
PubMed1996

Rate constant of gadolinium (Gd)-DTPA transfer into chronic subdural hematomas.

Gadolinium (Gd) DTPA concentrations in subdural fluid and arterial blood were measured following intravenous Gd-DTPA injection by ion coupled plasma emission spectrometry in 31 chronic subdural hematomas and 12 with subdural effusions. Dynamic biological modeling analysis was used to calculate the unidirectional transfer rate constant (K) for Gd-DTPA influx into the subdural fluid. The Gd concentrations in subdural hematomas and subdural effusions were 36.3 +/- 3.7 nmol ml(-1) and 80.0 +/- 14.0 nmol ml(-1), respectively. The transfer rate constants (K) for subdural hematomas and subdural effusions were 12.4 +/- 1.5 (x10(-4)) min(-1) and 19.7 +/- 2.2(x10(-4)) min(-1), respectively. The Gd concentration and transfer rate constant for subdural effusions were significantly (p<0.05) higher than for subdural hematoma. The Gd transfer rate constant was significantly correlated with the interval from head injury to operation. The present study shows that the immature outer membrane has a high transfer rate constant, allowing extravasation of plasma components into the subdural space and increasing the volume of the subdural effusion; the rate constant decreases with aging of the subdural hematoma.

Adolescent↗
PubMed1998

Quantitative kinetic analysis of blood vessels in the outer membranes of chronic subdural hematomas.

Dynamic biologic modeling was used to calculate the transfer rate constant for gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) and capillary permeability in the outer membrane of chronic subdural hematomas and effusions. Following intravenous Gd-DTPA injection, Gd concentrations in the subdural fluid and in timed arterial blood samples were measured by ion-coupled plasma emission spectrometry in 53 chronic subdural hematomas and 18 chronic subdural effusions. The capillary surface area in outer membrane was assessed morphometrically. Transfer rate constants for subdural hematomas and subdural effusions were 12.4 +/- 1.0 and 20.6 +/- 1.7 (x 10(-4)min-1, respectively. Capillary permeabilities for subdural hematomas and subdural effusions were 16 +/- 1.2 and 19 +/- 3.7 ml.min-1(mm2/mm3)-1, respectively. The capillary surface areas for subdural hematomas and subdural effusions were 48 +/- 3 and 77 +/- 10 mm2/mm3, respectively. The high degree of infiltration of Gd into subdural effusions reflects the high capillary surface area in the outer membrane rather than greater permeability of individual capillaries. The value of transfer rate constant was correlated inversely with the duration of the chronic subdural fluid collection. Immature outer membrane has a high transfer rate constant which allows extravasation of plasma components into the subdural space, resulting in increasing volume of the subdural effusion. Delayed magnetic resonance imaging following Gd administration may be clinically useful for estimating the age of chronic subdural fluid accumulations.

Aged↗
PubMed1997

Role of P-450 arachidonic acid epoxygenase in the response of cerebral blood flow to glutamate in rats.

BACKGROUND AND PURPOSE: Glutamate, a major excitatory neurotransmitter in the brain, has been implicated in the hyperemic response to increases in the activity of neurons, but the mechanism of glutamate-induced dilation of cerebral blood vessels is unknown. Glutamate has been shown to enhance the release of arachidonic acid (AA) in brain tissue and cultured astrocytes. We have previously shown that astrocytes metabolize AA to vasodilator products, epoxyeicostrienoic acids (EETs), and express a P-450 AA epoxygenase, P-450 2C11. We tested the hypothesis that glutamate-induced dilation of cerebral arterioles is mediated in part by changes in the formation and release of EETs by perivascular astrocytes. METHODS: Primary astrocyte cultures were prepared from 3-day-old rat pups. The cells were labeled with [14C]AA, and the effect of glutamate on the formation of EETs from [14C]AA by cultured astrocytes was studied. The expression of P-450 2C11 protein in the microsomal fractions of cultured astrocytes was assessed by Western blot. In vivo cerebral blood flow measurements were made in adult rats by laser-Doppler flowmetry after administration of glutamate into the subdural space of the rat before and after treatment with miconazole. RESULTS: Glutamate treatment (100 mumol/L for 30 minutes) induced a threefold increase in the formation of EETs from [14C]AA by cultured astrocytes, and the increase was inhibited by miconazole (20 mumol/L), an inhibitor of P-450 AA epoxygenase. Treatment with glutamate (100 mumol/L) for 12 hours increased the expression of P-450 2C11 protein in the microsomal fraction of cultured astrocytes. The response of laser-Doppler cerebral blood flow to administration of glutamate (500 mumol/L) into the subdural space of the rat was significantly attenuated after treatment with miconazole (20 mumol/L for 30 minutes). CONCLUSIONS: These findings suggest a role for a P-450 AA epoxygenase in astrocytes in the coupling between the metabolic activity of neurons and regional blood flow in the brain.

Animals↗
PubMed2004

Spontaneous arachnoid cyst rupture in a previously asymptomatic child: a case report.

UNLABELLED: Arachnoid cysts are benign congenital cavities arising in the subarachnoid space. Non-traumatic subdural effusion of cerebrospinal fluid is a rare complication requiring surgical treatment. CASE REPORT: A 15-year-old boy was admitted to the hospital because of symptoms related to acute intracranial hypertension (headache and vomiting). The cerebral CT-scan revealed a subdural hygroma adjoining a voluminous Sylvian arachnoid cyst. Two arachnoid cysts were incidentally discovered 11 years before this dramatic complication. Moreover, the patient had suffered a cerebral concussion 2 years earlier, but interestingly did not develop cystic hemorrhage or rupture, contrary to numerous cases previously described in the literature. The location of the cysts and their regular follow-up did not allow foreseeing a cystic rupture. Hygroma evacuation was first performed after which a subdural peritoneal shunting, using a programmable opening pressure valve, was implanted. Spontaneous rupture into the subdural space represents an unusual complication of arachnoid cysts. Clinical aspects, radiographic findings, pathogenesis and surgical management are described. It is important to point out that subdural hygroma or haematoma should never be excluded in the absence of trauma history, even in the case of small non-progressive cysts regularly supervised.

Adolescent↗
PubMed1994

Repeated multifocal recurrence of grade I, grade II, and grade III meningiomas: regional multicentricity (primary new growth) or metastases?

In this study 48 patients with histologic grade I and 41 with grade II/III meningiomas were reviewed retrospectively for the occurrence of multifocal tumor masses in relation to recurrence. Regional multicentric tumor masses were increasingly seen in progressive disease with repeated recurrence and occurred significantly more frequently in grade II/III compared to grade I meningiomas. Small microscopic tumor extensions along the subdural space around the tumor bulk, defined as tumor spurs, could be documented as an alternative form of multifocal disease. The occurrence of these spurs was associated with recurrence. In nearly all cases the multifocal disease was limited to the vicinity of the primary or previous tumor site. In three patients with grade III meningiomas however, at recurrence distant tumors could be found. These were interpreted as drop, cerebrospinal fluid and hematogenic metastases, respectively. In these three cases tumor spurs were documented in previous operations. It is concluded that not only primary new growth in a tumor that virtually from the beginning already has a regional multifocal origin, but also the spread of tumor cells along the subdural space forming tumor spurs, as well as distant metastases, plays an important role in recurrent meningioma.

Brain Neoplasms↗
PubMed1999

Comparison of cerebral blood flow and injury following intracerebral and subdural hematoma in the rat.

Subdural hematomas (SDH) can induce ischemia and neuronal damage in the underlying cortex. However, the extent to which intracerebral hematomas (ICH) produce reductions in cerebral blood flow (CBF) sufficient to cause ischemic damage is uncertain. Intracranial hemorrhage was induced by the injection of 100 or 200 microl of blood into the subdural space (SDH) or into the caudate nucleus (ICH) of the rat. CBF was measured using [14C]-iodoantipyrine autoradiography at 4 h. Brain damage was measured using 2,3, 5-triphenyl tetrazolium chloride (TTC) staining at 24 h and brain edema was measured using the wet/dry weight method. Brain ion contents were measured at 24 h using a flame photometer and chloridometer. In the CBF studies, the volume of tissue perfused below the ischemic threshold (<20 ml/100 g/min) for SDH was 122+/-35 mm3 (sham: 3.3+/-1.7 mm3). Following ICH, there was a small volume of tissue perfused below the ischemic threshold 50+/-11 mm3 (sham: 3. 3+/-2.5 mm3) but this volume corresponded closely to the volume of clot (71+/-5 mm3). The extent of brain damage, measured by TTC staining, in the cerebral cortex correlated with the increasing volume of the subdural blood clot (sham: 9+/-3 mm3; 200 microl: 81+/-19 mm3; P<0.01). Conversely, minimal brain damage was detected following ICH. The injection of blood into the subdural space or into the brain parenchyma induced blood volume-dependent increases in brain water content at 24 h. Increases in brain water content after SDH, were confined to the cerebral cortex (sham: 0.1+/-0.1 g/g dry weight; 200 microl: 0.8+/-0.3 g/g dry weight; P<0.001). In contrast, increases in brain water content after ICH were predominantly in the subcortical region (sham: 0.1+/-0.1 g/g dry weight; 200 microl: 0.4+/-0.2 g/g dry weight; P<0.01). The present investigations demonstrate differences in CBF, brain injury and edema formation following SDH and ICH indicating that these conditions may require different therapeutic interventions.

Animals↗
PubMed1986

[Anatomo-microscopic study of the walls of the superior cerebral veins].

The authors studied the structure and disposition of the tissue components of the tunicae of the superior cerebral veins at the levels of the subdural space and of the superior sagittal sinus. It was observed that, at the level of the transition vein-sinus, the tunica adventitia is formed by numerous and voluminous fascicles of collagenic fibers and thin elastic fibers, which describe system spirals more opened distant to the superior sagittal sinus. The tunica intima of these vascular segments exhibits an endothelium resting on a network of elastic fibers, which may play the role of an internal elastic lamina. From the lateral, superior and inferior walls of the sinus, there originates a connective system whose fascicles of collagenic and elastic fibers incorporated to the vascular walls after describing a stretch in spiral around the vascular lumen. The authors admit that this dispositive connective collagenic-elastic, more the presence of the septums fibrous of the venous walls, give to the superior cerebral veins one property of the lengthening and of the shortening of the walls, in order to regulate the blood debit to the sinus. Also, ist was noted that, at the level of the subdural space, vascular walls exhibits a fibrous structure similar to that of the sinus, and are fixed to the interne face of the cranial dura-mater, to the lateral wall of the sinus and to the falx cerebri. These adherences contribute to preserve the integrity of the walls and even of the resistance during the elevation of the venous pression, preventing to the collapsus of these veins.

Adult↗
PubMed2000

The fate of the cerebrospinal fluid after neuroendoscopic third ventriculostomy.

This paper describes the case of a 9-year-old girl with a posterior thalamic/pineal region lesion and secondary obstructive hydrocephalus. The hydrocephalus was treated by neuroendoscopic third ventriculostomy (NTV), and she underwent simultaneous transendoscopic biopsy. The tumour biopsy was haemorrhagic, but the bleeding settled with constant irrigation. The patient remained neurologically unchanged, but subsequent imaging revealed an asymptomatic thoracolumbar spinal subdural haematoma thought to be due to blood flowing out through the NTV into the subdural space. This demonstrates the subdural location of the cerebrospinal fluid after NTV.

Biopsy↗
PubMedDate not supplied

[Post-traumatic subdural hygroma: diagnostic conditions and therapeutic attitude in Gabon].

An excessive collection of cerebrospinal fluid in the subdural space is known as subdural hygroma, or hydroma. By far, the most common cause is severe cranial trauma. The diagnosis can be made by angiography or computer tomography and, with certainly, only by trephine or burr hole evacuation. 11 cases of post-traumatic subdural hygromas, mainly diagnosed during operative interventions, from April 1981 to September 1988, are reported. Most patients had acute forms of hygroma requiring acute surgical intervention. The acuteness could broken down as: coma (medium Glasgow coma scale: 6), lateralizing neurologic signs (4 cases) and temporal lobe herniation signs (7 cases). There were difficulties in obtaining angiographic studies. 10 patients underwent burr hole evacuation. Craniectomy was performed in one case. Time between cranial trauma and surgical intervention varied from 24 hours (6 cases) to 34 days. It appears that the prognosis is related to the extent of primary brain damage and not to the pressure exerted by the (usually) small mass lesion. The authors propose a clinical management of this lesion and hope for improvement in the diagnostic technics available.

Adolescent↗
PubMed1977

Angiographic characteristics of certain subdural collections of fluid.

The presence of abnormal amounts of fluid in the subdural space has been referred to as subdural hematoma, subdural effusion and subdural hygroma. These are supposed to be differentiated by the appearance of the fluid and the presence of membranes in the dubdural space. Although both hygroma and chronic subdural hematoma are liquid, space-occupying lesions which cause pressure in the underlying brain, we have found that there are definite angiographic, clinical and prognostic differences between them. These differences are described.

Cerebral Angiography↗
PubMed2007

Infantile lumbosacral spinal subdural abscess with sacral dermal sinus tract.

STUDY DESIGN: Clinical case report of a spinal subdural abscess in an infant presenting with sacral dermal sinus tract (DST). OBJECTIVES: To suggest that sacral DST with caudal direction may require surgical resection as early as possible. SUMMARY OF BACKGROUND DATA: DST may induce the formation of a spinal abscess. However, it is sometimes difficult to decide on early surgical resection for DST, especially in cases that are located at a lower level than the lumbar spine and directed caudally that is not accompanied by cerebrospinal fluid leakage. METHODS: A 9-month-old girl was transferred due to intermittent fever and vomiting, with the midline sinus of the lower back at the second sacral spinal level. She showed mild tenderness of the lower back and slight weakness of both lower extremities with increased residual urine volume of the bladder. Magnetic resonance imaging (MRI) showed that the low-lying sacral DST traced into the subdural space with caudal orientation, and the presence of extensive subdural spinal abscess from the first lumbar spine to the fourth sacrum. RESULTS: Emergency resection of the sacral DST was performed after laminotomy from the first lumbar spine to the second sacrum, and the subdural spinal abscess was also surgically removed. After 8 weeks of intravenous antibiotic treatment, she showed no neurologic deficit and no evidence of residual abscess on MRI. CONCLUSION: We suggest that even low-lying sacral DST may require surgical resection as early as possible because it may result in indolent and extensive spinal abscesses.

Abscess↗
PubMed2003

Inadvertent subdural spread complicating cervical epidural steroid injection with local anaesthetic agent.

Although cervical epidural steroid injection with local anaesthetic is considered a safe technique and widely practiced, complications may occur. We report a patient experiencing unexpected delayed high block, moderate hypotension and unconsciousness eight to ten minutes after an apparently normal cervical epidural steroid injection. The most probable diagnosis was a subdural block. Anatomical peculiarities of the epidural and subdural space in the cervical region increase the risk of subdural spread during cervical epidural injection. Fluoroscopic guidance is important during cervical epidural injection to increase certainty of correct needle placement, thus minimizing the risk of complications.

Analgesia, Epidural↗
PubMed1998

Inflammatory cytokines locally elevated in chronic subdural haematoma.

The involvement of inflammation in the development and propagation of chronic subdural haematoma (CSH) was investigated by measuring the levels of inflammatory cytokines (tumour necrosis factor [TNF] alpha, interleukin [IL]-1 beta, IL-6, and IL-8). Peripheral venous blood and subdural fluid were obtained at the time of burr hole surgery from 34 patients with CSH and from 9 with subdural effusion. The levels of the inflammatory cytokines were analysed by enzyme-linked immunosorbent assay. The blood levels of TNF alpha, IL-1 beta, IL-6, and IL-8 in both CSH and subdural effusion groups were almost within the range of normal subjects, and no differences were observed between the two groups. IL-6 and IL-8 in the subdural fluid were much higher than in the blood of both groups, and the levels in CSH patients were significantly higher (10 times) than in subdural effusion patients. Local elevation of inflammatory cytokines in the subdural space of both CSH and subdural effusion without systemic change suggests the presence of local inflammation in the two diseases. The same behavioural patterns of cytokines for these and higher levels of cytokines in the CSH also suggest that inflammatory cytokines may be involved in the continuous development from subdural effusion to CSH and propagation of CSH.

Adult↗
PubMed1997

[An autopsy case of multiple myeloma with pineal body and spinal cord dura mater infiltration].

An autopsy case of multiple myeloma (IgD lambda type) with pineal body and spinal cord dura mater infiltration is reported. The 63-year-old man was diagnosed as multiple myeloma (IgD lambda type). He was treated with melphalan and prednisolone. Extra bone marrow masses developed 1 year after the onset. He died with renal failure. At autopsy there were many extra bone marrow masses including pineal body and dura mater of the thoracic cord. Microscopic examination revealed that those mass lesions consisted of neoplastic plasma cells. Myeloma cells also infiltrated perivascular space near the pineal body, subdural space of the cerebrum and brain stem. The cells were labeled VS 38 c immunohistochemically. We discussed routes of the metastasis to the central nervous system of the multiple myeloma. This case suggests that the way of myeloma cells infiltration to the pineal body is hematogenous metastasis, because pineal body have no blood brain barrier.

Dura Mater↗
PubMed1996

[Ultrasound of extracerebral spaces in infants: standardized examination technique].

High resolution ultrasound (5/7.5 MHz, linear array) allows imaging of the extracerebral space in infants. A standardised state-of-the-art imaging technique is described that can be performed during routine cranial sonography. Diagnosing dilated subarachnoid space is possible by comparison to normal values. Pathological findings of the subarachnoid and subdural space can be differentiated. Evaluation of the following conditions is possible: external hydrocephalus, cortical atrophy, pyogenic meningitis, subdural hematoma and hygroma. High resolution ultrasound can add helpful information in situations in which magnetic resonance imaging or computed tomography were previously needed. Since it is a noninvasive method, ultrasound is ideal for follow-up studies and hence the method of choice.

Dilatation, Pathologic↗