Dural liposarcoma associated with subdural hematoma. Case report.

Abstract

On September 1, 1966, a 4-month-old baby girl was admitted to the hospital because of increasing head circumference and intermittent vomiting. No history of birth trauma or head injury could be obtained. First Admission. Head circumference was 18 inches, the fontanel full, and the scalp veins prominent. Radiographs showed marked separation of the sutures. The hemoglobin was 85 %. Fontanel aspiration yielded 40 cc of blood-stained fluid from the subdural cavity of each side, and thereafter 25 cc from each side on four successive days. Operation. On September 5, bitemporal burr holes drained further amounts of subdural hematoma and revealed a thin subdural membrane on the right side; there was no membrane on the left side. A 4F rubber tube placed in the right subdural cavity was removed the following day. The fontanel remained concave until the 10th postoperative day when it became tense; subdural tap released 30 cc of blood-stained fluid from the right side and 5 to 10 cc from the left side. Eleven days after the burr hole operation, unhealthy-looking skin over the right temporal burr hole was excised, and an additional burr hole was made more posteriorly on the right side, through which further subdural hematoma escaped. The right subdural space was drained with a 4F rubber catheter for 3 days. When the baby went home on September 23, 1966, the head circumference was 17.5 inches and the fontanel concave. Second Admission. On December 31, 1968, the child now 2 years 7 months was readmitted to the hospital because of headaches, vomiting, and increasing drowsiness of 4 weeks' duration. She was thin and pale, with slight neck rigidity. There was bilateral papilledema with retinal hemorrhages. The temperature was 36.2~ the head circumference 20 inches, and the fontanel fused. The right posterior burr hole was bulging but not tense. Power in the limbs was normal, reflexes uniformly brisk, and plantar responses both extensor. The hemoglobin was 79%, white blood cell count 84,000 cu mm with predominant polymorphs, and the sedimentation rate 50 mm in the first hour. X-ray films of the skull showed marked separation of sutures. The serum electrolytes were normal and the blood urea 37 mg%. Bilateral carotid angiograms showed a lens-shaped filling defect on the right anteroposterior venogram, and the left lateral venogram showed a filling defect in the posterior parietal region. Operation. On January 1, 1969, a burr hole placed just above and behind the left