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PubMed1992

[Surgical outcome of 32 cases in traumatic subdural hygroma].

32 cases of traumatic subdural hygroma (TSH) in adults with surgical treatment were retrospectively investigated by means by clinical features and CT findings. The cases consisted of 29 males and 3 females, aged 41 to 87 years (mean 69). Preparative CT scan of all cases revealed low density area and crescent shape in frontotemporal or frontoparietal subdural space. Half of the cases had bilateral lesions. At operation of TSH, color of subdural fluid collections was more water clear or xanthochromic than bloody. As a results, 22 out of 32 cases (69%) in TSH improved with surgical treatment. Many of effective cases of surgical treatment in TSH had short interval from trauma to operation and light disturbance of consciousness before operation. However, the other intracranial damage will also affect the clinical outcome of TSH, because the majority of cases in this study was accompanied by an intracranial damage including cerebral contusion, subarachnoid hemorrhage or intracranial hemorrhage. Nevertheless, surgical management for TSH was so effective that the operation should be undergone sooner interval from trauma, simultaneously considering the another intracranial lesions except TSH. But then, we experienced 7 cases (22%) of ventricular dilatation and 5 cases (16%) of chronic subdural hematoma in postoperative follow up CT scans. In 5 cases among the former, ventriculoperitonial shunt was done, and in 3 cases among the latter, burr hole evacuation was performed. Therefore, the postoperative course of TSH should require careful observation by CT scan and so on.

Adult↗
PubMed1989

[Clinical study of chronic subdural hematoma and hygroma in two hospitals for elderly patients with dementia].

The authors have investigated the incidence of chronic subdural hematoma and hygroma (CSH) in two hospitals for elderly patients with dementia syndrome over a period of three years and nine months. All observed patients had been in the hospital for 2 weeks or more and had had brain computed tomography (CT) on admission. The total of 613 patients included 212 males and 401 females. Based on the CT findings observed in patients on admission, the authors found 47 patients with CSH. This was equivalent to 7.7% of all patients observed. After admission, almost all patients had brain CT twice per year, with a mean of 2.2 CT examinations during the observation period. Sixteen patients who had no CSH on admission developed CSH. Thus a total of 63 (10.3%) demented patients demonstrated CSH during the observation period. It was assumed that the high incidence of CSH in this study may be due to the practice of performing routine CT examinations in hospitalized patients and the fact that demented patients are prone to fall and hit their heads. From the investigation of past history, tastes, and patterns of daily behavior, we found the risk factors for CSH development to be male sex, alcohol abuse and wandering as a symptom of dementia. We performed CT examinations on all patients who showed subjective or objective neuro-symptoms related to the central nervous system, but we could find only 2 patients with high-density lesions in the subdural space that indicated acute bleeding. This was only 3.1% (2/65) of all patients who developed subdural effusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1999

Posttraumatic subdural hygroma: CT findings and differential diagnosis.

Subdural hygroma is a cerebrospinal fluid accumulation in the subdural space. It is an epiphenomenon of head injury. CT is the preferred diagnostic imaging modality. Differential diagnosis has to be made with chronic subdural hematoma, and atrophy with enlargement of the subarachnoid space. As time goes by, subdural hygroma either resolves, or it becomes a chronic subdural hematoma. Neurosurgical evacuation is only required when mass effect creates neurologic symptoms.

Aged↗
PubMed1993

[Multiple myeloma presenting with a solitary cranial tumor with subdural extension: a case report].

We report a case of multiple myeloma presenting with a solitary cranial tumor in the frontal region, extending from subcutaneous tissue to subdural space. To our knowledge, invasion of a tumor beyond the dura mater has never been described in case of multiple myeloma presenting with a solitary calvarial tumor. In the present case, the subdural extension was clearly visualized by several diagnostic means. A 53-year-old female patient visited the clinic of our University Hospital, complaining of a left frontal mass in May 1991. The mass grew rapidly, and she was hospitalized in June. On admission, neurological examination showed nothing abnormal. Laboratory studies showed normocytic normochromic anemia. Protein electrophoresis disclosed hypergammaglobulinemia with S-spike, and serum paraprotein was specific to IgA with lambda light chains by immunoelectrophoresis. Urinary Bence-Jones protein was not detected. An osteolytic lesion visualized in the frontal bone on plain skull radiographs showed destruction of the frontal bone, and an enhanced mass extending from the epidural to subcutaneous space was shown by computed tomography. The mass had compressed the frontal lobe. T1-weighted magnetic resonance images of the area showed isointensity signals, homogeneously enhanced with gadolinium-diethylenetriamide pentaacetic acid. Subdural extension in the deep area of the tumor was suggested. At operation, we confirmed infiltration of the tumor from the dura mater into the subdural space. Postoperative biopsy of bone marrow of the iliac bone demonstrated myeloma cells. The tumor was histologically diagnosed as plasmacytoma. The patient was highly resistant to postoperative combined therapy, and started on a fatal course leading to respiratory insufficiency caused by interstitial pneumonia in April 1992.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1978

Calcified congenital arachnoid cyst with heterotopic neuroglia in wall.

Two unique findings, advanced calcification and ectopic neuroglia, were encountered in the wall of a giant congenital arachnoid cyst occurring in a 40 year old woman. The cyst almost totally filled the supratentorial subdural space of the left hemicranial cavity, was not connected with the subarachnoid space, and thus developed intra-arachnoidally. Its congenitally derived nature was supported by the unique finding of heterotopic neuroglia in the wall. Congenital arachnoid cyst must be distinguished from various cystic lesions within the central nervous system, including the neuroepithelial cyst which can arise throughout the neuraxis. It is suggested that pathogenesis of the congenital arachnoid cyst is related to aberrant flow of the ventricular cerebrospinal fluid into the developing leptomeninx in the process of differentiation of the subarachnoid space. The tract or pouch may occur within the arachnoid mater, and the cyst is formed intra-arachnoidally when the former filled with fluid is closed off from the subarachnoid space.

Adult↗
PubMedDate not supplied

Accidental subdural injection during attempted lumbar epidural block may present as a failed or inadequate block: radiographic evidence.

BACKGROUND AND OBJECTIVES: Until now, case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a delayed onset, after low doses of local anesthetic, with a characteristic radiographic appearance on contrast injection. Our radiographic investigation of atypical "epidural" blocks has revealed that subdural injection may go unrecognized clinically and may be a cause of inadequate blocks. The mechanism is explored. CASE REPORTS: A radiographic study of 35 cases of atypical or inadequate blocks for cesarean delivery has unexpectedly revealed four instances of subdural contrast injection. On imaging, only localized posterior spread of subdural contrast was detected in these 4 cases, unlike the more widespread distribution previously reported after extensive neuraxial blocks. Recent findings on the ultrastructure of the subdural space are reviewed and related to the new clinical findings, which include inadequate blocks and pain developing on postoperative reinjections. CONCLUSIONS: Accidental subdural injection may now be added to the list of causes of failed or inadequate "epidural" block. Clinicians should be aware of the diagnosis of a possible subdural injection, if a poor quality block with restricted spread and slow onset is associated with pain on postoperative reinjection of the catheter.

Adult↗
PubMed2005

Subdural extension of recurrent olfactory neuroblastoma. Case report.

A 37-year-old man presented with olfactory neuroblastoma, which apparently recurred as diffuse extension in the subdural space of the cranial vault and spinal column 3 years after initial resection. Head and spinal magnetic resonance imaging with gadolinium demonstrated a subdural lesion. Cytological examination of the cerebrospinal fluid was negative. Histological examination of a biopsy specimen suggested recurrence of the olfactory neuroblastoma. This type of recurrence is very unusual.

Adult↗
PubMed1994

[Nontraumatic acute subdural hematoma caused by the rupture of transdural anastomotic vessels in moyamoya disease].

A case of nontraumatic acute subdural hematoma caused by the rupture of transdural anastomotic vessels in a patient with Moyamoya disease is reported. The patient was a 55-year-old woman who was admitted to our hospital in a comatose state. A diagnosis of acute subdural hematoma associated with Moyamoya disease was made on the basis of CT and angiographic findings. No lesions suggestive of trauma, such as cerebral contusion, could be detected during surgery. Although total evacuation of the hematoma was performed, she developed the apallic syndrome and did not recover consciousness. Judging from the angiographic and operative findings, it appears that subarachnoid hemorrhage occurred first and stretched the transdural anastomotic vessels which supplied the collateral circulation. This led to tearing of some of the vessels, and their proximal ends were consequently exposed in the subdural space. The surgical treatment of acute subdural hematoma associated with Moyamoya disease requires the closest attention to avoid damage to the collateral circulation. Although we carefully arrested the bleeding without using a coagulator in order to spare the collateral vessels, the transdural anastomosis was no longer visible on postoperative angiograms. Our experience suggests that hematoma irrigation with trephination therapy, which may minimize the damage to the collateral circulation, may be the most appropriate treatment for acute subdural hematoma associated with Moyamoya disease. Furthermore, cerebral revascularization should be performed for the treatment of the circulatory disturbance intercepted by the hematoma itself or by operative manipulation.

Acute Disease↗
PubMed1997

Spontaneous lumbar subdural haematoma--a case report.

Spinal subdural haematomas are a rare cause of spinal cord or cauda equina compression. These are usually seen in association with lumbar puncture or coagulopathy. Spontaneous spinal subdural haematomas are even rarer. This report presents one such case diagnosed by magnetic resonance imaging (MRI) together with a review of the literature. The patient presented with low back pain of acute onset after minimal trauma. MRI showed high signal intensity on both T1-weighted and T2-weighted sequences in the posterior subdural space indicative of a subacute lumbar subdural haematoma. There was no history of bleeding diasthesis. The patient was treated conservatively and recovered spontaneously.

Hematoma, Subdural↗
PubMed1989

Subdural injection of local anesthetics and morphine: a complication of attempted epidural anesthesia.

We have reported a case of unintentional, roentgenographically proven cannulation of the lumbar subdural space. Injection of 13 ml of local anesthetic provided satisfactory anesthesia for cesarean section, and administration of 1 mg of morphine resulted in postcesarean analgesia for 22 hours. Subdural catheterization is a possible explanation for the occasionally irregular course of an apparent "epidural" anesthetic.

Adult↗
PubMed1999

Subdural injection of contrast medium as a complication of myelography.

In a retrospective evaluation of 654 canine and feline myelograms, 58 were found to have been complicated by injection of the contrast medium into the subdural space. The medium was present predominantly dorsal to the spinal cord, with a sharp dorsal border and an undulating ventral border. Confirmation that this myelographic appearance was due to subdural localisation was achieved using fresh cadavers injected with contrast medium labelled with Indian ink. It was further showed that the dorsal accumulation of contrast medium was due to the denticulate ligaments which restricted the ventral extension of the contrast medium.

Animals↗
PubMed1993

Epidural and subdural contrast in myelography and CT myelography.

A retrospective study of 624 lumbar myelographic and CT myelographic procedures was undertaken to evaluate the frequency, radiographic and clinical relevance of contrast medium outside the dural sac. Our findings indicate that epidural contrast is frequently identified on CT scans with highly sensitive window settings (in 35.4% of all CT myelographic studies). Standard myelographic films are less sensitive for the detection of epidural contrast (9.6%). Subdural contrast is far less often encountered (in 2.4% of CT myelographic studies and in 3.2% of standard myelographic films). We believe leakage of contrast to occur through the puncture site into the epidural and subdural space.

Adult↗
PubMed2004

Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours.

In malignant brain tumours which may disseminate staging, usually by cranial and spinal MRI is necessary. If MRI is performed in the postoperative period pitfalls should be considered. Nonspecific subdural contrast enhancement on spinal staging MRI is rarely reported after resection of posterior fossa tumours, which may be mistaken for dissemination of malignancy. We investigated the frequency of spinal subdural enhancement after posterior cranial fossa neurosurgery in children. We reviewed 53 postoperative spinal MRI studies performed for staging of paediatric malignant brain tumours, mainly infratentorial primitive neuroectodermal tumours 2-40 days after surgery. There was contrast enhancement in the spinal subdural space in seven cases. This was not seen in any of eight patients who had been operated upon for a supratentorial tumour. After resection of 45 posterior cranial fossa tumours the frequency of subdural enhancement was 15.5%. MRI showing subdural enhancement was obtained up to 25 days postoperatively. No patient with subdural enhancement had cerebrospinal fluid (CSF) examinations positive for tumour cells or developed dissemination of disease in the CSF. Because the characteristic appearances of subdural contrast enhancement, appropriate interpretation is possible; diagnosis of neoplastic meningitis should rarely be impeded. Because of the striking similarity to that in patients with a low CSF-pressure syndrome and in view of the fact that only resection of tumours of the posterior cranial fossa, usually associated with obstructive hydrocephalus, was followed by this type of enhancement one might suggest that rapid changes in CSF pressure are implicated, rather the effects of blood introduced into the spinal canal at surgery.

Adolescent↗
PubMedDate not supplied

[Extra-arachnoid subdural injection, an accident of peridural anesthesia].

Two cases are presented, with accidents of peridural anesthesia, Anesthesia of the entire brain stem, paralysis of the intercostal muscles, and of the upper limbs, apnoea and miosis that developed later indicate an extension of the anesthetic effects far higher that it could have been expected considering the technical details of the procedure. On the other hand the absence of any durable coma, of extreme mydriasis, and of severe arterial hypotension, as well as the relatively rapid retrocession of the additional effects of the administration of an anesthetic exclude the possibility of total rachianesthesia, and it can be concluded that there was an accidental injection of anesthetic in the extra-arachnoid subdural space.

Adult↗
PubMed1980

[Subdural abscess in infant and child (author's transl].

Two cases of subdural abscess in infant and child treated with irrigation via burr holes were reported. The first case was a 1.4-year-old boy with right hemiparesis and mental retardation since severe head trauma at 9 months old. The patient with manifested with an acute onset of high fever followed by disturbance of consciousness and convulsive seizures 2.5 months prior to admission to our department. During admission in the other hospital, the diagnosis of septicemia caused by E. coli was made by blood cultures when CT scan demonstrated a huge lentiform low density area over the right hemisphere and contralateral crescent low density area. The low density area on the right side was well circumscribed by high density rim which was enhanced by contrast medium. Under the diagnosis of bilateral subdural abscess secondary to septicemia caused by E. coli, irrigation of the purulent cavity was carried out. The contralateral low density area was found to be chronic subdural effusion. The second case of 3-month-old infant who complained of high fever, neck stiffness, unconsciousness and right hemiconvulsions 8 days prior to admission. CT scan showed bilateral crescent low density areas indicating subdural effusion. Subdural punctures performed via the fontanelle revealed pus in the left subdural space and xanthocromic fluid in the right side. The low density area on CT scan was changed to the lentiform high density area circumscribed smooth high density rim during the course of the patient. The subdural abscess was treated with irrigation via burr holes. In this report, the etiology of the subdural abscess and route of infection in addition to follow up study of CT findings were presented with the literature.

Brain Abscess↗
PubMed2003

Subdural catheter migration may lead to baclofen pump dysfunction.

OBJECTIVES: To report an unusual cause of intrathecal drug delivery failure in baclofen pump device. STUDY DESIGN: A case report of an SCI patient treated with intrathecal baclofen, presenting a drug withdrawal. SETTING: Regional spinal cord injuries centre in Geneva (Switzerland). METHODS: We present a case of a 38-year-old male with complete T9 spastic paraplegia for 15 years, treated with intrathecal baclofen for 11 years. He recently presented to our centre with a spastic hypertonic episode, associated with rhabdomyolysis. RESULTS: Standard investigations were unrevealing. However, a CT scan performed after injecting a radio-opaque solution by the side port of the pump, showed an unexpected catheter migration into the subdural space. Surgical revision reversed withdrawal symptoms. CONCLUSIONS: Subdural catheter migration must be considered in the differential diagnosis of intrathecal drug delivery system failures. We recommend the use of the CT scan after contrast injection, to detect the localization of the distal catheter tip and confirm the normal diffusion into the subarachnoid space.

Accidental Falls↗
PubMed1995

[Diagnosis of accidental subdural block].

Accidental subdural block occurred in a 47-year-old man who underwent gastrectomy under nitrous oxide-sevoflurane anesthesia combined with continuous epidural block. The development of subdural block was suspected from unexpectedly severe hypotension with small doses of mepivacaine during operation and was confirmed by a characteristic X-ray photograph after operation. The subdural block should be suspected from abnormal changes in vital signs and by careful observation of X-ray photographs, because it is not always easy to determine the presence of contrast media either in the subdural space or in the epidural space.

Anesthesia, Epidural↗