1/132. Treatment of a symptomatic posterior fossa subdural effusion in a child.We describe the first observation of a child with a posterior fossa subdural effusion with secondary hydrocephalus and tonsillar herniation. We diagnosed this entity in a 14-month-old girl with no history of trauma or coagulation disorder. The patient presented in our emergency department with opisthotonus and raised intracranial pressure resulting from supratentorial hydrocephalus. An emergency ventriculo-peritoneal shunt was placed, which resolved the symptoms only temporarily. Eventually external drainage of the subdural fluid was performed. The collection gradually disappeared, and both the external subdural shunt and the ventriculo-peritoneal shunt were removed. The patient made a complete neurological recovery. We review the physiopathology and treatment of subdural effusions in general, and propose some guidelines for the management of symptomatic effusions occurring in the posterior fossa in particular.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
2/132. Ruptured distal anterior choroidal artery aneurysm presenting with casting intraventricular haemorrhage.This report describes a rare case of a distal anterior choroidal artery aneurysm which developed intraventricular haemorrhage without subarachnoid haemorrhage as shown on computerized tomographic (CT) scan. A 69-year-old hypertensive man suddenly became unconscious. An emergency CT scan showed a severe intraventricular haemorrhage and a small round low-dense lesion within the haematoma at the right trigone. The haematoma with obstructive hydrocephalus made the lateral ventricles larger on the right than on the left. CT scan could not detect any subarachnoid haemorrhage. Right interal carotid angiography revealed a saccular aneurysm at the plexal point of the right anterior choroidal artery. We approached the aneurysm and the small round lesion through the trigone via a right temporo-occipital corticotomy. We could clip the aneurysmal neck and remove the intraventricular haematoma and the papillary cystic mass (corresponding to the small round lesion on CT scan) totally in one sitting. Histological examination revealed the aneurysm to be a true one and the papillary cystic mass to be a choroid plexus cyst.- - - - - - - - - - ranking = 0.092679070739391keywords = haematoma, haemorrhage (Clic here for more details about this article) |
3/132. Subdural empyema complicating cerebrospinal fluid shunt infection.Subdural empyema has not been reported previously as a complication of cerebrospinal fluid (CSF) shunt surgery. An infant submitted to CSF shunt insertion for congenital hydrocephalus developed subdural empyema after a failed attempt to treat a superficial scalp wound infection with oral antibiotics. enterobacter cloacae was isolated from the empyema. Temporizing management of the preceding superficial wound infection with oral antibiotics probably was the cause of this exotic pathogen. The treatment of infected scalp wounds contiguous with shunt hardware must be surgical.- - - - - - - - - - ranking = 0.125keywords = subdural (Clic here for more details about this article) |
4/132. Severe factor v deficiency and neonatal intracranial haemorrhage: a case report.We report a case of severe factor V (FV) deficiency (<1%) associated with multiple episodes of intracranial bleeding which presented at birth. The clinical course was further complicated by the development of an inhibitor, episodes of sepsis and cardiac failure. The management using virally inactivated FFP and platelets is discussed.- - - - - - - - - - ranking = 0.027337758167keywords = haemorrhage (Clic here for more details about this article) |
5/132. Unilateral posthaemorrhagic hydrocephalus in the neonatal period or later in infancy.Five infants who developed unilateral hydrocephalus associated with antenatal or perinatal intraventricular haemorrhage (IVH) in the neonatal period or later in infancy are reported. Unilateral hydrocephalus occurred following discharge home in four of our five cases, two of whom had been treated during the neonatal period with either serial lumbar punctures or punctures from a Rickham reservoir. An obstruction at the level of the foramen of Monro following a large subependymal matrix bleed appeared to be the underlying aetiology. These data suggest that infants who suffer a predominantly unilateral IVH, with or without parenchymal involvement, can subsequently develop unilateral hydrocephalus. Cranial ultrasound examinations should be repeated at regular intervals during the first year of life, as unilateral hydrocephalus can still develop after a period of apparent stabilization.- - - - - - - - - - ranking = 0.0068344395417499keywords = haemorrhage (Clic here for more details about this article) |
6/132. Symptomatic calcified subdural hematomas.Two unique cases of chronic calcified subdural hematomas are reported in children as a long-term complication of a ventriculoperitoneal shunt. Both the patients had undergone shunt procedures in infancy for congenital hydrocephalus. In one patient, the cause of the hydrocephalus was aqueduct stenosis, while in the second patient, a lumbar meningomyelocele was associated with hydrocephalus. In both these patients, a ventriculoperitoneal shunt was done in infancy. In one of them, following the shunt surgery, a bilateral subdural collection was noticed which required burr hole evacuation. Both the patients remained asymptomatic for 9 years, when they presented to our center with acute raised intracranial pressure and contralateral hemiparesis. Both the patients had a relatively short history and had altered sensorium at admission. Surprisingly, in both the patients, the CT scan showed significant mass effect producing calcified subdural hematomas. The shunt systems were found to be working well at surgery. craniotomy and excision of the calcified subdural hematomas was undertaken. Postoperatively, the patients showed satisfactory recovery, and at discharge the patients were doing well. At the follow-up at the outpatient clinic, the patients were asymptomatic.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
7/132. An unusual complication of tapping a ventriculoperitoneal shunt.A case is reported describing a complication of an unsuccessful attempt to aspirate the reservoir of a ventriculoperitoneal shunt system with a suspected shunt infection. This arose due to a misunderstanding of the anatomy of the shunt and resulted in an intracerebral haematoma. The complications of cerebrospinal fluid shunting and the difficulty in the diagnosis thereof are outlined. We discuss the role and method of shunt tapping in diagnosing shunt problems before reviewing the literature describing the rationale. The variation in shunt design is emphasized. Guidelines are then proposed not to dissuade physicians from tapping shunts but to ensure that the procedure is performed safely and in collaboration with neurosurgical units.- - - - - - - - - - ranking = 0.012667851468464keywords = haematoma (Clic here for more details about this article) |
8/132. Simultaneous subdural effusion and hydrocephalus in infancy.hydrocephalus and subdural hematoma or effusion of infancy rarely present simultaneously, where both are active contributors to acutely increased intracranial pressure. In three cases, clinical findings characteristic of both were present. decompression of one can facilitate expansion of the other. Rapid progression of unsuspected hydrocephalus could be responsible for some of the poor results reported after treatment of subdural effusion alone. This possibility should be considered whenever progress is unsatisfactory during treatment of subdural effusion.- - - - - - - - - - ranking = 0.875keywords = subdural (Clic here for more details about this article) |
9/132. Hemorrhagic subdural effusion complicating an endoscopic III ventriculostomy.subdural effusion, a common postoperative complication of extracranial shunting for hydrocephalus, is usually caused by excessive drainage of cerebrospinal fluid. subdural effusion is thought to occur less frequently after a neuroendoscopic III ventriculostomy, and no reported cases have been symptomatic. We encountered a symptomatic subdural effusion with a component of hemorrhage 5 days after the latter procedure was performed to treat massive hydrocephalus in a 2-year-old boy.- - - - - - - - - - ranking = 0.625keywords = subdural (Clic here for more details about this article) |
10/132. Increasing chronic subdural hematoma after endoscopic III ventriculostomy.OBJECT: Endoscopic III ventriculostomy (ETV) is an effective and a rather safe treatment for noncommunicating hydrocephalus secondary to aqueductal stenosis and other obstructive pathologies. Though not devoid of risk, ETV is increasingly replacing shunt operations, and it prevents related complications, including overdrainage. methods: We report a rare case of a large chronic subdural hematoma (ChSDH) after ETV in a patient with aqueductal stenosis. Three weeks after he was shunted elsewhere, he presented to us with clinical symptoms of intracranial hypotension and overdrainage. ETV was performed and the shunt removed uneventfully. On routine postoperative MRI a few weeks later, a large ChSDH was noted, the patient being totally asymptomatic. Since the ChSDH grew significantly, causing a mass effect on the follow-up MRI, it was finally drained. Large and increasing ChSDHs have previously been reported secondary to overdrainage after shunt placement, but not after ETV. CONCLUSIONS: We conclude that though rare, a ChSDH may evolve even after ETV, if there is a substantial decrease in previously elevated intracranial pressure.- - - - - - - - - - ranking = 0.625keywords = subdural (Clic here for more details about this article) |
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