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PubMed1992

Subdural effusions: determination of contrast medium influx from CSF to the fluid accumulation by computed tomography as an aid to the indications for management.

In 46 patients with subdural effusions CSF dynamics and especially the influx of contrast medium from CSF to the subdural fluid accumulation was investigated by serial computed tomography (CT). In 16 cases the subdural effusion was of traumatic and in 30 cases of non-traumatic origin. The results allowed a subdivision of the patients into three groups. Group 1: patients without contrast medium influx into the subdural fluid accumulation; group 2: patients with delayed influx; group 3: patients with immediate influx. In group 1 patients the subdural effusion acted as a space-occupying process with absolute indication for surgical treatment. Also in group 2 patients the further course showed that a surgical indication was given, because the fluid accumulation did not resolve under conservative management but increased in size, and/or the neurological deficit worsened. In all group 3 patients the subdural effusions decreased and finally disappeared conservatively. Group 1 patients with effusions on traumatic origin generally had more severe injuries than the patients of the other groups. The investigations caused no serious complications. This diagnostic method proved to be a reliable means for early differentiation between the possibility of conservative management or the indication for operative treatment in cases with subdural effusions of different origin.

Adolescent↗
PubMed1988

Posterior fossa subdural effusion due to head trauma.

We report 3 cases of posterior fossa subdural effusion resulting from head trauma, and we review 20 previously reported cases. All patients with the acute type presented with progressive deterioration of consciousness associated with stiff neck, seizure, and dyspnea (apnea). By contrast, in the subacute or chronic type, persistent headache, multiple cranial nerve pareses, and ataxia were characteristic. Occipital bone fracture was common in the acute type, and supratentorial subdural effusion was more frequently associated with the subacute or chronic type. Evacuation of the subdural fluid collection through a burr hole is the most common and effective treatment, but subdural-peritoneal shunting or closed drainage of the subdural fluid collection may be necessary. The prognosis of posterior fossa subdural effusion after head trauma is relatively good.

Aged↗
PubMed1980

Direct subdural scintigraphy. Report of a case with subdural effusion following pneumococcal meningitis.

We report a case of pneumococcal meningitis in an 8 weeks olf female infant followed by persistent subdural effusion successfully treated by repeated subdural taps. The initial delineation of the subdural effusion, the decrease in size and the disappearance of the fluid were demonstrated by direct subdural scintigraphy (D.S.S.). The literature of pneumococcal meningitis, its diagnosis, treatment and complications are reviewed, and it is suggested that direct subdural scintigraphy should be employed as a diagnostic aid in the evaluation and follow up of subdural effusions.

Female↗
PubMedDate not supplied

[Improved diagnosis of subdural effusions in infants--importance of sonography and the noninvasive measurement of intracranial pressure].

The detection of small frontal and high-parietal subdural effusions by ultrasound examination has some problems of methods. The diagnostic accuracy of the noninvasive investigation may be improved by using the following proceeding. The application of a short-focus transducer (focus-zone 1 to 4 cm) instead of the usual medium-focus transducer; The noninvasive measurement of intracranial pressure by aplanation-tonometry of the fontanelle. We report our results with this proceeding in 35 infants with liquid accumulation between cortex and cranium (27 infants with subdural effusions, 8 infants with enlarged subarachnoid spaces because of brain atrophy). The ultrasound features of a flattened superficial relief of brain-cortex and a wedge-shaped enlarged interhemispheric fissure are morphologic references to subdural effusions. Strong reflexions of the convexly arched superficial relief of brain-cortex, an enlarged interhemisphaeric fissure with parallel vertical bounds and enlarged lateral ventricles in the frontal parts with irregular outlines are signs for brain atrophy with enlarged subarachnoid spaces. If sonographic signs do not allow an accurate diagnosis, the noninvasive measurement of intracranial pressure bei aplanation-tonometry enables us to discriminate between subdural effusion and enlarged subarachnoid spaces by measuring a rised basic pressure and pathologic pressure waves (results from 26 long-term measurements in the above-mentioned 35 infants).

Humans↗
PubMed1984

Infantile subdural effusions. A case report.

A case of post-traumatic infantile subdural effusion is reported in which spontaneous resolution did not occur. The patient developed features of raised intracranial pressure 1 month after a head injury and required drainage of the persistent effusions followed by shunting of the hydrocephalus. The pathology and management of subdural effusions are discussed.

Brain Injuries↗
PubMed2001

Cerebral cysticercus granuloma associated with a subdural effusion.

The association of a solitary cerebral cysticercus granuloma with a subdural effusion is being reported. The granuloma and the effusion resolved following albendazole therapy. We speculate that the spread of the inflammatory changes around the granuloma to the subdural space could have led to the development of the subdural effusion.

Adult↗
PubMed1975

Subdural effusion and brain tumor: case report and survey of the literature.

Optic glioma associated with bilateral subdural effusion in a four-month-old male infant is reported. Review of the cases with subdural effusion or hematoma and brain tumor in the world literature was made. When subdural effusion is found in a newborn or an older infant, the possibility of an associated brain tumor must be considered. Care also should be taken to search for an underlying brain tumor and to exclude dural metastasis when we deal with chronic subdural hematoma in an adult.

Angiography↗
PubMed1981

Subdural effusion following radical surgery for chiasmal region tumors in children. Report of 4 cases.

4 cases of subdural effusion occurring after radical surgery for chiasmal region tumors in children are reported. The pathogenetic mechanisms of this disorder are explained at least partly by a change from internal to external hydrocephalus or brain atrophy in 2 of the 4 cases, whereas the pathogenesis is unclear in the remaining 2 cases. In all 4 cases meningitis did not supervene postoperatively. The subdural effusion may be divided roughly into two types according to symptomatology: "serious type' which presents with severe symptoms and "mild type' which is virtually asymptomatic. The serious type requires immediate surgical procedure, such as continuous subdural drainage and subduroperitoneal shunt, while the mild type should be carefully monitored for the course of subdural effusion by CT scan.

Adolescent↗
PubMed1981

[Computed tomography in subdural effusions of infancy (author's transl)].

31 out of 128 infants with abnormal neurological signs show areas of decreased radiodensity of computed tomography (CT) over the cerebral hemispheres, primarily frontal. It is emphasized, that the diagnosis of subdural effusions is permitted in cases with decreased density over the frontal lobes and hardly visible cerebral sulci as well as wedge-shaped widening of the interhemispheric fissure. But in cases with decreased density over the frontal regions and prominent cerebral sulci a subdural effusion cannot be excluded. In association with signs of increased intracranial pressure these CT findings are yet indicative of subdural effusion. Are there to delimitate two spaces of different density between skull and cortex the diagnosis of subdural effusion is certain already by means of CT-morphological criteria. The therapeutic regimen is dependent upon the clinical symptoms.

Diagnosis, Differential↗
PubMed1997

[Subdural effusion in type B Haemophilus influenzae meningitis. A study of 38 cases].

OBJECTIVE: Studying clinical, laboratory and radiologic findings, as well as outcome, observed in patients with meningitis caused by Hib, and its relationship with subdural effusion. MATERIAL AND METHODS: Retrospective study of 38 meningitis caused by Hib. Patients were aged between 3 months and 5 years. Imaging was performed in 26 cases (68%): CT in 21 children (55%) and cranial sonography in 11 cases (29%). EEG was made in 29 patients (76%) and auditory-evoked potentials in 13 (34%). The mean follow-up period after discharge was 24 months. RESULTS: Sixty-six per cent were male and 34% female. Eight cases had subdural effusion. These patients showed higher white cell counts in blood and CSF, higher levels of proteins in CSF, and lower levels of glucose in the same medium. They also had seizures before or during hospitalization, with higher frequency than those without subdural effusion (50% vs 26%) as well as more prolonged fever (127 vs 73 hours). No specific treatment was required in any case. CONCLUSIONS: Subdural effusion is one of the most frequent complications observed in meningitis. Patients frequently present more important clinical and laboratory alterations. This finding is not related with neurologic sequelae and they resolve spontaneously with time.

Brain↗
PubMed1994

Evolution of chronic subdural hematoma after burr-hole exploration for subdural effusion--case report.

A 57-year-old male developed subdural effusion after head trauma, which remained asymptomatic and unchanged in volume during a follow-up period of 3 months. A typical chronic subdural hematoma (CSDH) developed 6 weeks after burr-hole exploration in spite of the absence of hematoma capsule or blood components in the effusion. The CSDH was successfully treated by irrigation and drainage. This case suggests that the presence of blood in subdural effusion may be the trigger for evolution of CSDH. We recommend that asymptomatic subdural effusion should be followed up without surgical intervention.

Brain↗
PubMed1981

[Subdural effusion following radical surgery for chiasmal region tumors in children--report of 4 cases (author's transl)].

Four cases of subdural effusion following radical surgery for the chiasmal region tumors in childhood were presented in this report. Three out of four cases were craniopharyngioma and the remaining one was optic glioma. The pathogenetic mechanisms of this disorder were explained probably and at least partly by a change from internal to external hydrocephalus or craniocerebral disproportion due to cerebral atrophy in two of the four cases and unclear in the remaining two cases. In all four cases meningitis did not supervene postoperatively. The subdural effusion may be divided into two types according to symptomatology, i.e., "serious type" which presents with severe symptoms and "mild-type" which is virtually asymptomatic. The serious type required immediate surgical procedure, such as continuous subdural drainage and subduroperitoneal shunt, while the mild type should be carefully monitored for the course of subdural effusion by CT scan.

Adolescent↗
PubMed1990

[A case of subdural effusion secondary to dural metastasis of prostatic cancer: case report].

The authors reported a case of subdural effusion secondary to dural metastasis of prostatic cancer. A 61-year-old man was referred for headache, vomiting and gait disturbance. He had undergone hormonal therapy for prostatic cancer. He showed a mild left hemiparesis and anemia without bleeding. CT-scan disclosed a multilobular crescent shaped low density area in the right hemisphere. Under the diagnosis of chronic subdural hematoma, burr hole irrigation therapy was performed. Xanthochromic fluid was evacuated from the subdural space, in which no tumor cells were shown to exist. CT-scan on the 21st day disclosed a low density area, which was diagnosed as recurrent chronic subdural effusion. Therefore, craniotomy was performed to evacuate the subdural fluid and to explore the dura mater. Removal of the red hemorrhagic tumor at the dura mater and the fluid was performed. The patient died of heart failure in the 16th month despite complete recovery after the second operation. Histopathological examination of the tumor revealed adenocarcinoma at the outer part of the dura mater and the adjacent skull bone, where capillaries were embolized with tumor cells. However, no tumor cells were found in the subdural fluid. The authors could find in the literature 30 cases of subdural hematoma or effusion secondary to dural metastasis of carcinoma. The pathogenesis of the subdural hematoma in this case might be due to circulatory disturbance at the dura mater brought about by the invasion of the tumor or tumor cells emboli in the capillaries.

Adenocarcinoma↗
PubMed1981

Juvenile xanthogranuloma with recurrent subdural effusions.

A 2-year-old girl with extensive cutaneous xanthogranuloma and recurrent subdural effusions has been investigated. Differentiation from histiocytosis X depended upon light and electron microscopical studies of the cutaneous infiltrate and cells obtained from the cerebrospinal fluid. The recurrent subdural effusions responded well to cranial irradiation. Although juvenile xanthogranuloma is generally a benign cutaneous disorder, a spectrum of naevoid proliferative changes involving systemic organs may occur.

Child, Preschool↗
PubMed1990

Surgical indications for infantile subdural effusion.

Thirty-four cases of infantile subdural effusion (ISE) were reviewed in relation to surgical treatment and its prognosis during an average of 4 years of extended follow-up. The surgical indications were determined mainly by the size of the ISE on computed tomography (CT) scan and by metrizamide CT cisternography (MCTC). Consequently, 18 cases were categorized as type A according to MCTC, including 11 cases (61.1%) of ISE CT grade 1. All type A cases were closely observed. This nontreatment regimen yielded excellent results in 15 cases (83.3%). For 10 cases categorized as type B according to MCTC, including 5 cases (50%) of ISE CT grade 3, surgical treatment was indicated and excellent results were obtained in 8 cases (80%). For 6 cases categorized as type C according to MCTC and as ISE CT grade 3, surgery yielded excellent results in 4 cases (66.7%). Antiepileptic drugs have been given to three (27.3%) of the 11 patients who had convulsive attacks. In conclusion, the surgical indications for ISE were based mainly on MCTC in addition to the clinical course, and it is emphasized that, in the early stages, surgery on ISE cases categorized as MCTC types B and C is necessary.

Anthropometry↗
PubMed1984

[Sonographic detection of subdural effusions in infancy].

Using the open fontanelle as an acustic window, small frontoparietal subdural effusions are often missed on conventional sagittal or coronar ultrasonographic sections. Using horizontal and frontal skull sections during the first 12 months of life intracranial structures can equally be visualized. In a study of 14 infants aged 6 days to 11 months gray scale ultrasonography was compared to computed axial tomography. The results suggest that horizontal and frontal ultrasonographic skull sections are equally efficient to localize even small subdural effusions without the adverse risks of radiation.

Brain↗
PubMed2006

Subdural effusions in the posterior fossa associated with spontaneous intracranial hypotension.

BACKGROUND: Misdiagnosis of spontaneous intracranial hypotension remains a problem, despite increasing recognition. METHODS: Three patients with spontaneous intracranial hypotension presented with typical findings on lumbar puncture, magnetic resonance (MR) imaging, and radioisotope cisternography. All patients showed subdural effusions in the posterior fossa on axial T2-weighted MR imaging. Axial MR images of 112 patients with other conditions were also screened for this finding. RESULTS: One of three patients had typical orthostatic headache, and the other two had continuous headache. The finding of subdural effusions in the posterior fossa on axial T2-weighted MR imaging disappeared after treatment. Similar findings were found in 14 of 112 patients with other conditions. Most of the patients were over 60 years old or had dementia or previous radiation therapy. CONCLUSIONS: Subdural effusions in the posterior fossa can be identified by T2-weighted axial MR imaging, and are useful for the diagnosis of spontaneous intracranial hypotension and for verifying the effectiveness of treatment.

Adult↗