Acute subdural hydroma simulating syndrome of extradural hemorrhage

Abstract

A LTHOUGH the classical signs and treatment for acute epidural hemorrhage are well known, it is not generally recognized that following head trauma an acute unilateral collection of clear fluid in the subdural space may give rise to similar symptoms and demand prompt operative drainage of the subdural space. Naffziger,l Cohen,’ Dandy,3 Love,4 Walsh and Sheldon5 and others have called attention to collections of clear fluid in the subdural space following head trauma resulting in symptoms of cerebral compression often simulating subdural hematoma. This accumulation of fluid may result in acute or chronic symptoms, and since it cannot be removed by spinal drainage, an opening in the dura is necessary. It is believed that the fluid enters the subdural space through a rent in the arachnoid and becomes trapped. Case 1 illustrates how an acute collection of this clear fluid in the subdural space can simulate the classical symptoms and signs of middle meningeal extradural hemorrhage.