Cases reported "Subdural Effusion"

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1/93. 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.
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2/93. 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.
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3/93. Arachnoid cyst rupture with concurrent subdural hygroma.

    arachnoid cysts (ACs) are relatively common intracranial mass lesions, which occur most often in the middle cranial fossa. While these lesions can present as a mass lesion, many are asymptomatic. Rarely, posttraumatic or spontaneous rupture of ACs can result in intracystic hemorrhage, subdural hematoma or subdural hygroma. We have encountered two cases of ruptured arachnoid cysts that resulted in subdural hygromas. Both patients harbored middle cranial fossa cysts and suffered mild closed head injuries. The presentation, radiographic findings and surgical management of these patients as well as the association between ACs and subdural hygromas are described.
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4/93. 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.
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5/93. 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.
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6/93. Arachnoid cyst with spontaneous rupture into the subdural space.

    Spontaneous rupture of an arachnoid cyst into the subdural space is an unusual complication. Only six cases have been reported in the literature. We report here an additional case and review the literature concerning arachnoid cysts. The possible pathogenesis of this condition is discussed.
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7/93. Bilateral subdural effusion and subcutaneous swelling with normally functioning csf shunt.

    We report a child with hydrocephalus due to tuberculous meningitis who developed a subcutaneous fluid collection around the ventriculoperitoneal shunt tube entry point, after one month of shunting. On investigation, he had decompressed ventricles with bilateral fronto parietal subdural hygroma. Bifrontal burr hole drainage helped resolution of both subdural effusion and subcutaneous scalp swelling. This complication is unique and its pathogenesis has been postulated.
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8/93. 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.
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9/93. Bilateral subdural effusions related to disease activity in familial hemophagocytic lymphohistiocytosis in an 8-month-old infant.

    An 8-month-old girl had classic features of hemophagocytic lymphohistiocytosis (HLH). A presumptive diagnosis of familial hemophagocytic lymphohistiocytosis was made on the basis of her age and the presence of parental consanguinity. In view of abnormal neurologic findings at presentation, a magnetic resonance imaging scan was performed and showed bilateral proteinaceous subdural effusions. These resolved within 1 week of commencement of chemotherapy for the primary condition. These subdural effusions were the only objective documentations of central nervous system involvement, along with an increased cerebrospinal fluid protein level. We also report other radiologic findings of HLH, which are of use in strengthening this diagnosis in individuals in whom the diagnosis is strongly suspected.
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10/93. Bilateral subdural collections--an unusual feature of possible Kawasaki disease.

    A case of possible Kawasaki disease presenting with bilateral subdural collections is reported. A 6-month-old boy was admitted to hospital following a prolonged partial seizure. He showed signs of worsening encephalopathy and was treated for presumed infective meningoencephalitis. Imaging revealed bilateral subdural collections. Pyrexia and irritability continued despite appropriate antibiotic and antiviral therapy suggesting a vasculitic process. The mucocutaneous signs normally associated with Kawasaki disease were subtle and fleeting in this infant. There was a dramatic clinical response to intravenous immunoglobulin and high dose aspirin. At 2-year follow-up the boy has made a complete recovery with no echocardiographic evidence of coronary artery aneurysm and resolution of subdural collections. Kawasaki disease or other vasculitides should be considered in the differential diagnosis of acute subdural collections in infancy.
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