Subdural collections of infancy and setting sun sign may be asymptomatic and benign or symptomatic and aggressive

Abstract

Objective: subdural collections of infancy may be asymptomatic and benign or symptomatic and agressive. We present two cases illustrating both clinical scenarios. The presence of setting-sun sign is an unusual feature in both cases. Clinical presentation: the diagnosis of benign subdural collections of infancy depends on several distinct clinical and laboratory findings, which are reflected in these two cases: patient age less than 1 year, macrocrania (Case 1 was 79 cm), normal psychomotor development, no history of CNS infection or head trauma; subdural fluid clear yellow; erythrocyte count less than 1 ml/mm³. Both cases presented with setting sun sign. CT scans showed craniofacial disproportion, disjunction of the sutures, low measures of attenuation coefficient values, relatively normal ventricular size, and no cerebral atrophy. MRI also showed agenesis of the corpus callosum, in case 1. Intervention: based on megacrania associated with poor visualizations of the cerebral sulci, Case 1 was treated with a subdural collection-peritoneal shunt; Case 2 was treated with clinical observation due to enlarged subarachnoid spaces. Conclusion: we present two cases with different clinical courses - one more aggressive than the other. We believe these two cases illustrate a disease process that is not always benign, particularly in view of setting-sun sign, and thus warrants a more accurate terminology. Regardless of terminology, however, even symptomatic cases can have good outcome with conservative treatment. Good outcome relies on close observation associated with complete workup that evaluates signs and symptoms of discompensation.