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Subdural Effusion
Effusion Subdural

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]

Neurologic

  • 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 Weakness [medlineplus.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 Weakness [medlineplus.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]

  • Cognitive Impairment

    Cognitive and neuropsychiatric outcomes Cognitive and neuropsychiatric impairments following bacterial meningitis can be the result of direct damage to cerebral structures by the infection or can be secondary to complications from the infection. [pulmonarychronicles.com]

    Careful history and physical examination can help differentiate these conditions. 18 Older patients, however, often have underlying neurological disease and differentiating acute findings; cognitive impairment and changes from the patient’s baseline may [ahcmedia.com]

  • 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]

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]

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]

The evolution of MRI and the advent of neuroendoscopic surgery have resuscitated the interest in the classification, etiology and pathophysiology of hydrocephalus. [books.google.com]

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]

Our study has one important limitation: the etiology was confirmed only in 45% of patients. [ispub.com]

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]

This study in the South Asian nation also provides with the epidemiological data of this important neurosurgical entity. [jneuro.com]

Epidemiology Frequency United States Subdural empyema accounts for 15-22% of focal intracranial infections. Sinusitis is the most common predisposing factor in the developed world. International Frequency is similar to that in the Unites States. [emedicine.medscape.com]

WHO Weekly Epidemiological Record 2015; 27 March, 2015, 90 th Year; No. 13. Vol. 90. 2015. p. 121-32. Available from: http://www.who.int/wer. [Last cited on 2015 Apr 22]. 2. Meningococcus. [jacmjournal.org]

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]

Pathophysiology

An attempt is made to explain the possible underlying pathophysiological mechanism of malignant subdural haemorrhagic effusion. [ncbi.nlm.nih.gov]

The evolution of MRI and the advent of neuroendoscopic surgery have resuscitated the interest in the classification, etiology and pathophysiology of hydrocephalus. [books.google.com]

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]

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]

If frequent taps are required, vary the puncture site slightly to prevent fistula formation. Following the procedure, apply pressure to the scalp for 2 to 3 minutes to prevent fluid leak from the puncture site or subgaleal fluid collection. [doctorlib.info]

[…] 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]

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