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Subdural Effusion


Presentation

  • 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.[ncbi.nlm.nih.gov]
  • We present a case of an 8-year-old boy who presented with progressive head enlargement and worsening pulsatile peri-orbital swelling of 1 year duration.[ncbi.nlm.nih.gov]
  • We report a 29-year-old man with a unique presentation of vasculitis as acute unilateral subdural effusion and meningoencephalitis. Magnetic resonance imaging showed a brainstem lesion that spread to the thalamus over time.[ncbi.nlm.nih.gov]
  • Approximately 10 patients with such presentations have been reported. The authors report the case of a 5-year-old boy with multiple subdural masses and SDE.[ncbi.nlm.nih.gov]
  • To-and-fro communication between the subdural effusion and ventricles is considered to be present in these patients.[ncbi.nlm.nih.gov]
Collapse
  • A collapse of the sinuses is known to be present in some infants with external hydrocephalus, but collapsed sinuses have not been previously described in patients with TSE and associated hydrocephalus.[ncbi.nlm.nih.gov]
Intermittent Fever
  • This case report describes a 7-month-old H. influenzae type b meningitis patient who had initial presentations of prolonged intermittent fever and vague neurologic signs.[ncbi.nlm.nih.gov]
Malignant Pleural Effusion
  • Malignant pleural effusions often contain actual malignant cells. Effusion, Subdural Effusion, Pleural Presence of fluid in the pleural cavity resulting from excessive transudation or exudation from the pleural surfaces.[healthdictionary.info]
Skin Lesion
  • A biopsy of a skin lesion was considered suggestive of JXG. Skin, eyes, brain, lungs, liver, and testicles were involved. Systemic treatment of JXG was begun with vinblastine. It allowed the regression of skin, lung, and CNS lesions.[ncbi.nlm.nih.gov]
Lethargy
  • A 6-month-old female infant presented with lethargy, poor appetite, and persistent vomiting after head trauma 2 weeks previously.[ncbi.nlm.nih.gov]
  • Symptoms may include: Outward curving of a baby's soft spot ( bulging fontanelle ) Abnormally wide spaces in the bony joints of a baby's skull ( separated sutures ) Increased head circumference No energy ( lethargy ) Persistent fever Seizures Vomiting[nlm.nih.gov]
Bulging Fontanelle
  • Clinical, infants Bulging fontanelle, widened sutures, increased head circumference, persistent fever, increased intracranial pressure, leading to vomiting, seizures.[medical-dictionary.thefreedictionary.com]
  • Symptoms may include: Outward curving of a baby's soft spot ( bulging fontanelle ) Abnormally wide spaces in the bony joints of a baby's skull ( separated sutures ) Increased head circumference No energy ( lethargy ) Persistent fever Seizures Vomiting[nlm.nih.gov]
Opisthotonus
  • 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.[ncbi.nlm.nih.gov]

Workup

  • […] common cause of macrocephaly (macrocrania) 9 more common in males than in females in majority of cases, there is a family history of macrocephaly Associations scaphocephaly 10 Often discovered incidentally or when patients undergo neuroimaging in the workup[radiopaedia.org]
  • If the infant is hypoglycaemic, also consider a metabolic workup. CT head is important to rule out a mass lesion or evidence of trauma once adequate airway secured.[intensivecarenetwork.com]

Treatment

  • In this study, the surgical treatments for infantile PM complicated by SE were investigated.[ncbi.nlm.nih.gov]
  • We aimed to compare the effective rate of effusion removal and the standardized morbidity ratio of poor prognosis of the two different treatments, and to discuss the future treatment methods possible.[ncbi.nlm.nih.gov]
  • OBJECTIVE: This study aimed to introduce an effective treatment for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury (TBI) and to analyze the underlying mechanism.[ncbi.nlm.nih.gov]
  • This possibility should be considered whenever progress is unsatisfactory during treatment of subdural effusion.[ncbi.nlm.nih.gov]
  • A neurosurgical operation was performed in 7 infants because of the poor effect of the above treatment. In these 7 infants the encapsulation process was nearly complete.[ncbi.nlm.nih.gov]

Prognosis

  • The standardized morbidity ratio of poor prognosis (observed/expected poor prognosis) was 0.56 (95 % CI: 0.32-0.80) for the conservative treatment group versus 0.25 (95 % CI: 18 0.08-0.42) for the surgical procedure group.[ncbi.nlm.nih.gov]
  • The prognosis of posterior fossa subdural effusion after head trauma is relatively good.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • The prognosis of subdural effusion is not as benign as that of enlargement of subarachnoid spaces, requiring differential diagnosis between these disorders.[ncbi.nlm.nih.gov]
  • Treatment may include: Surgery to drain the effusion Drainage device, called a shunt, left in place for a short time or longer time Antibiotics given through a vein to treat the infection Outlook (Prognosis) Full recovery from a subdural effusion is expected[mclarenhealthplan.org]

Etiology

  • The location, depth and etiology of the subdural effusion, the surgical approach that was used and the recurrence rates were studied in these patients.[ncbi.nlm.nih.gov]
  • Subdural effusion in an infant is a rare clinical scenario which may be secondary to a variety of etiologies. Massive subdural effusion is an extremely rare complication of head injury.[ncbi.nlm.nih.gov]
  • In our study, the etiology of meningitis was identified by CSF culture in 70 of the 87 cases and by Gram stained smear in two additional cases(3).[indianpediatrics.net]

Epidemiology

  • Tallon JM, Ackroyd-Stolarz S, Karim SA, et al ; The epidemiology of surgically treated acute subdural and epidural hematomas in Can J Surg. 2008 Oct51(5):339-45.[patient.info]
  • WHO Weekly Epidemiological Record 2015; 27 March, 2015, 90 th Year; No. 13. Vol. 90. 2015. p. 121-32. Available from: . [Last cited on 2015 Apr 22]. 2. Meningococcus.[jacmjournal.org]
  • This study in the South Asian nation also provides with the epidemiological data of this important neurosurgical entity.[jneuro.com]
  • Subdural haematoma and effusion in infancy: an epidemiological study. Arch Dis Child 2005 ; 90 : 952 –5. Choux M , Lena G, Genitori L. Intracranial haematomas. In: Raimondi AJ, Choux M, di Rocco C, eds. Head injuries in the newborn and infant .[adc.bmj.com]
  • Subdural hematoma and effusion in infancy: an epidemiological study. Arch Dis Child. 2005;90:952. Ney JP, Joseph KR, Mitchell MH. Late subdural hygromas from birth trauma. Neurology. 2005;65:517. Whitby EH, Griffiths PD, Rutter S, et al.[doctorlib.info]
Sex distribution
Age distribution

Pathophysiology

  • The authors describe two patients with bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension (SIH) and discuss the possible pathophysiological origins of these abnormalities.[ncbi.nlm.nih.gov]
  • An attempt is made to explain the possible underlying pathophysiological mechanism of malignant subdural haemorrhagic effusion.[ncbi.nlm.nih.gov]
  • Increased ICP may also decrease cerebral flood flow, possibly causing ischemia and edema; this further increases the ICP, causing a vicious circle of pathophysiologic events.[emedicine.medscape.com]
  • Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. J Infect Dis 2002; 186(Suppl. 2):S225-S233. 8. Aronin SI, Peduzzi P, Quagliarello VJ.[ispub.com]
  • Pathophysiology An acute SDH is usually caused by either: Tearing of bridging veins from the cortex to one of the draining venous sinuses – typically occurring when bridging veins are sheared during rapid acceleration-deceleration of the head.[patient.info]

Prevention

  • Ultimately, cystoperitoneal shunt was carried out in a desperate attempt to prevent impending rupture of scalp sutures at sites of previous bur-hole placement. This was followed by not only complete resolution of hygroma but also visual recovery.[ncbi.nlm.nih.gov]
  • Abstract This study was performed to investigate the effect of early pressure dressing on the prevention of postoperative subdural effusion secondary to decompressive craniectomy (DC) in patients with severe traumatic brain injury (STBI).[ncbi.nlm.nih.gov]
  • […] an anti-siphon device which failed to prevent SDE.[neurologyindia.com]
  • […] sudden cardiac death - guidance (IPG603) Source: National Institute for Health and Care Excellence - NICE - 20 December 2017 Evidence-based recommendations on subcutaneous implantable cardioverter defibrillator insertion for preventing sudden cardiac[evidence.nhs.uk]
  • Four of the five deaths in her group of unrecognised abusive head injury might have been prevented.[adc.bmj.com]

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