Subdural Effusion Research Articles

An overlooked cause of subdural effusions

A middle-aged man presented with progressive confusion. Initial brain CT was misinterpreted to have ‘cerebral atrophy and bilateral subdural effusions’ by the emergency physician, and the patient was admitted to...

Experience in the treatment of desmoplastic infantile astrocytoma/ganglioglioma

Objective To explore the clinical characteristics, treatment and prognosis of desmoplastic infantile astrocytoma/ganglioglioma(DIA/DIG). Methods A retrospective analysis was conducted from April 2007 to October 2015 on a total of 6 cases with DIG/DIA who were admitted to Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University. Among them, 4 cases were male and 2 were female, and they were aged 2-19 months. The typical imaging findings included nodular enhancement commonly presenting cystic changes in superficial areas of cerebral hemispheres. The size of tumor was relatively large and could involve multiple lobes, in particular, the frontal and parietal lobes. Pathological examination revealed two-way differentiation of tumor cells to glial cells and neuroepithelium with GFAP (+ ), S-100 (+ ) and Vimentin (+ ), and Ki-67 (+ ) proliferation index was relatively low. Tumor resection was performed in all 6 cases. Postoperative subdural effusion and shunting were conducted in 1 case, and 2 cases underwent postoperative subdural effusion. The follow-up time ranged from 1 to 9 years. Results All 6 children with DIA/DIG (grade WHO Ⅰ) underwent total resection of tumors. Among them, 3 cases without undergoing subdural effusion or shunting surgery achieved good outcomes. Except temporary decrease in muscle strength occurring in 1 case, no other neurological disorders or epileptic seizures were reported. Among the 3 cases undergoing subsequent subdural effusion or shunting surgery, 1 case had good outcome, 1 case developed neurologic dysfunction, and 1 case died of infection. No metastasis spread through cerebrospinal fluid or tumor recurrence was observed. Conclusions DIG/DIA is a rare kind of intracranial tumor with common onset at less than 2 years old. The tumors are usually large and located in the superficial areas of the frontal and parietal lobes. DIG/DIA could have its unique imaging characteristics and the diagnosis could be established based on its typical pathological presentation. Good outcomes could be achieved through total resection of tumors. Key words: Glioma; Disease attributes; Therapy; Desmoplastic infantile astrocytoma/ganglioglioma

Venous or arterial blood components trigger more brain swelling, tissue death after acute subdural hematoma compared to elderly atrophic brain with subdural effusion (SDE) model rats

Acute subdural hematoma (ASDH) is a frequent complication of severe head injury, whose secondary ischemic lesions are often responsible for the severity of the disease. We focused on the differences of secondary ischemic lesions caused by the components, 0.4ml venous- or arterial-blood, or saline, infused in the subdural space, evaluating the differences in vivo model, using rats. The saline infused rats are made for elderly atrophic brain with subdural effusion (SDE) model.Our data showed that subdural blood, both venous- and arterial-blood, aggravate brain edema and lesion development more than SDE. This study is the first study, in which different fluids in rats’ subdural space, ASDH or SDE are compared with the extension of early and delayed brain damage by measuring brain edema and histological lesion volume.Blood constituents started to affect the degree of ischemia underneath the subdural hemorrhage, leading to more pronounced breakdown of the blood–brain barrier and brain damage. This indicates that further strategies to treat blood-dependent effects more efficiently are in view for patients with ASDH.

Longterm follow-up on patients with subdural effusions.

Seventy-two patients with subdural effusions who had been hospitalized in the Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Jakarta, were followed up for at least one year. Of the 72 patients, 35 were included nn this evaluation. Of the 35 patients, 16 were caused by purulent meningitis, and 19 by other diseases. On follow up examination comparison was made between the prognosis of patients with subdural effusions which dried in less than 2 weeks and subdural effusions which dried in more than 2 weeks or the patient who was asked to be discharged before the subdural effusions dried. The conclusion is that the former group has less neurological deficit, epileptic seizures, motoric and mental retardation than the latter. The prognosis is worse in patients with subdural effusions of long duration.

Subdural effusion complicating purulent meningitis.

The purpose of this paper is toevaluate the incidence, sex, age, nut-ritional condition, finding the effusi-on, mortality and, clinical signs andsymptoms which can support the di-agnosis of subdural effusion.

Spontaneous Intracranial Hypotension (SIH) and Idiopathic Intracranial Hypertension (IIH): Imaging Presentations

Background: Any change in Intracranial pressure (ICP), either elevation or reduction, could be with clinical and Neuroimaging presentations which depend to the severity of the pressure changes. The principal symptom in both of these syndromes, that is, Intracranial Hyper and Hypotension, is headache which in SIH , is mainly orthostatic or postural (positional) type which occurs when the patient is in upright position, and gradually disappears when the patient is lying down. In most cases, the headaches gradually increase from the moment the patient wakes up in the morning. However, in other cases the headaches are quick and severe. The acuteness of the headaches varies in each case, which affects how quickly the condition is diagnosed. Some of the other related symptoms in in intracranial hypotension state are loss of hearing, dizziness, tinnitus, vertigo, stiffness of the neck, nausea, Loss of consciousness, Coma and even vomiting. In Intracranial Hypertension situation transient visual obscuration or blurring ,double vision, visual loss and less likely joint pain ,low back pain and even intermittent ataxia. In neurological examinations cranial nerve palsies (mainly VI) may be found. In neuroimaging studies especially on MR imaging several nonspecific and heterogeneous presentations such as dural enhancement, vertical displacement of the brain (an appearance like Arnold-Chiari type I malformation ), subdural effusion or subdural hematomas mainly in chronic cases in Idiopathic intracranial hypotension and flattening of the posterior sclera, distension of perioptic subarachnoid space, tortuosity of optic nerve and an empty sella in Idiopathic intracranial Hypertension might be seen which the presence of 3 or more of the MRI features is 95% specific in predicting idiopathic intracranial hypertension. CSF leak is a recognized cause of intracranial hypotension. This condition may be spontaneous or secondary to spinal puncture; neurosurgical procedures (iatrogenically); dehydration; uremia and spinal trauma. In intracranial hypertension situation the etiology is unknown. However, two hypothesis are reduced CSF absorption at the level of the arachnoid villi and increased brain intraparenchymal water (Vasogenic brain edema). Objectives: Upon completion of this presentation, participants will be able to: 1) Recognize MRI appearance of the spontaneous intracranial hypotension and idiopathic intracranial hypertension (Pseudotumor cerebri). 2) Review their various clinical and imaging presentations. Conclusions: In this presentation we will review Imaging presentations of our several proved cases. As mentioned, there are heterogeneous groups of signs and symptoms and MRI presentation in these disorders which may cause misdiagnosis with other neurologic disorders and awareness, understanding, and recognition of these presentations may permit the radiologist to play a significant role in the prevention of misdiagnosis, unwanted surgical interventions or extensive diagnostic evaluation procedures.

Delayed extensive lumbar sub-dural effusion following discectomy - Clinical imaging and case report

Incidental durotomy during lumbar spine surgery is a commonly reported complication. Those presenting with cerebrospinal fluid (CSF) leak are usually recognized and repaired intraoperatively. In some circumstances, it may either be unrecognised or occur as a delayed complication. Such delayed occurrences cannot be predicted and its management remain a challenge to the surgeon, especially when it presents as a subdural effusion. We report a 55-year-old man who underwent mini open lumbar discectomy through left side for a prolapsed L4-L5 disc. Recurrent worsening radicular symptoms along with a palpable cystic swelling at the previous surgical site became eminent, three months after surgery. MRI revealed distinctive anterior translation of all rootlets with subdural fluid collection posterior to it, within a normally placed dura, extending from L1 to L5 levels. A concomitant pseudomeningocele with a fistulous tract was also evident. Draining of pseudomeningocele with widening of previous laminotomies revealed a dural defect of less than 0.5 cms that prompted the CSF leak. Subdural effusion was drained following which the defect was repaired with inlay polyester urethane dural substitute patch and augmented with fibrin sealant. Symptoms regressed and follow up was uneventful. Occurrence of sub-dural effusion in lumbar spine is inevitably uncommon. We advise to suspect this condition in patients with recurrent symptoms following satisfactory lumbar decompression surgeries. Recognising this condition, followed by appropriate drainage of subdural effusion and direct repair of the dural defect is highly recommended for a better prognosis.

Ruptured intracranial arachnoid cysts presented with subdural effusion or hematoma in children: clinical feature analysis and treatment outcome

Objective To analyze the clinical features, treatment strategies and outcome of ruptured intracranial arachnoid cysts(IACs) with subdural effusions or hematoma in children. Methods From January 2003 to January 2016, 49 ruptured IACs presented with subdural effusions, subdual and/or intracystic hematoma were retrospectively reviewed at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. The operative methods including burr hole in 16 cases, craniotomy and fenestration in 5 cases, cysto-peritoneal shunt (CPS) in 20cases, were indicated according to symptomatic presentation or significant radiological criteria. Eight cases were treated conservatively. Results The average age of the patients was 7.2±4.7 years, with the dominance of male(78%) and Galassi typeⅡ(53%) middle fossa(94%) IACs. The traumatic history was provided in 26(53%) cases. Raptured IAC were manifested as subdual and/or intracystic hemorrhage in 27(55%) and subdural effusion in 22(45%) patients. After a mean follow-up of 59.1 months in 47 patients, 3 cases disappeared spontaneously, 0 increased in size and all patients have symptomatic improvement. However, 14 of 30 burr hole need reoperation, with craniotomy in 4 and CPS in 10 cases. Shunt dependency occurred in 2 of 19 CPS (11%) and shunt revision was performed in 5(26%) CPS until the utility of programmable valves. Conclusion Subdural effusion or hematoma are probably supposed to have an underling IACs in children. Patients with raptured IACs can be treated conservatively in asymptomatic cases. As first procedure, burr hole and subdural drainage should be performed. Craniotomy or CPS should be reserved as the choice for special cases as alternative treatment. Programmable valves may contribute to decrease complications of CPS. Key words: Arachnoid cysts; Hematoma, subdural; Subdural effusion; Burr hole drainage; Cysto-peritoneal shunts

A novel variant of the GCDH gene causes glutaric aciduria type 1 in a Sudanese family: a case report

Background: Glutaric aciduria type 1 (GA1) is a rare autosomal recessive neurometabolic disorder caused by mutations in the glutaryl-CoA dehydrogenase gene (GCDH). If left untreated, it leads to accumulation of neurotoxic metabolites leading to poor neurological outcomes characterized by encephalopathic crises, subdural effusions and extrapyramidal features. Case presentation: We hereby report a consanguineous Sudanese family in which the father and two children were affected whilst the mother was an asymptomatic carrier. All had a novel guanine insertion in position c.1173_1174 (c.1173dupG), resulting in a frameshift and a stop codon downstream (p.Asn392Glufs4X). Conclusion: To our knowledge, this GCDH variant has not been previously reported. Genetic testing should be made widely available in communities where consanguinity is prevalent. This will allow detection of new pathogenic gene variants.

Malignant subdural effusion associated with burkitt lymphoma

Malignant subdural effusion associated with burkitt lymphoma

Efficacy of radiologic targeting epidural blood patch for spontaneous intracranial hypotension patients with multiple-level leakages of cerebrospinal fluid: an analysis of 36 cases

Thirty-six spontaneous intracranial hypotension patients with multiple-level leakages of cerebrospinal fluid were enrolled in the study.After 30 patients received targeted epidural blood intervention for 2 times and 6 patients received targeted epidural blood intervention for 3 times, the clinical symptoms were completely relieved.During injection of autologous blood, pain at the puncture site occurred in 24 cases, radiating pain in upper extremities in 5 cases, numbness in the upper extremity in 9 cases, radiating pain in lower extremities in 6 cases, numbness in lower extremities in 7 cases, headache in 4 cases, dizziness in 3 cases and transient bradycardia in 3 cases.Most of these symptoms were self-relieved after the end of injection or after slowing the injection rate, and some were self-relieved hours later.Neck stiffness was found in 2 cases and self-relived within a few hours or days after operation, and no severe nervous system-related complications were found.Recurrence happened in 2 cases at 3 months after the end of treatment, and the symptoms were self-relieved after receiving targeted epidural blood intervention for a second time.The patients were followed up for 15-36 months, and no serious nervous system-related complications were observed.Therefore, targeted epidural blood intervention is safe and effective when used to treat spontaneous intracranial hypotension caused by multiple-level leakages of cerebrospinal fluid in patients. Key words: Intracranial hypotention; Subdural effusion; Injections, epidural; Blood patch, epidural

Clinical analysis on 430 cases of infantile purulent meningitis.

BackgroundPurulent meningitis (PM) usually caused by a variety of pyogenic infection, is a kind of central nervous system infectious disease mostly common in children. It is easily misdiagnosed and its symptoms are varied. Excessive application of broad-spectrum antibiotics results in increased sickness and death of infants and young children. In this study, clinical data of 430 cases of PM in infants were analyzed to summarize the clinical experiences so as to achieve early diagnosis and early treatment of PM.ResultsMale-to-female ratio was 1.61:1, and the median age of incidence was 0.42 years. May was the modal month of onset (11.7%). Main clinical manifestations were fever (89.3%), vomiting (67.2%), mental fatigue (62.1%), anterior fontanelle full/bulging/high tension (54.2%), convulsion (52.6%), and meningeal irritation sign (24.7%). Cerebrospinal fluid (CSF) bacterial culture was done for 420 cases, of which 1.2% cases were positive. Blood culture was done for 146 cases of which 15.1% were positive. 175 (40.7%) cases had complications, among which 133 cases (76.0%) were subdural effusion, 21 cases (12.0%) were epilepsy.ConclusionInfantile PM is common in Spring, and May is the modal month of onset. The CSF/blood pathogen detection rate is very low and it is difficult to find evidence of cause. Fever, vomiting, mental fatigue and anterior fontanelle full/bulging/high tension, convulsion are the main clinical manifestations on which diagnosis depends. For those children diagnosed as PM and still having recurrent fever and prominent anterior fontanelle after treatment, clinicians should consider the probability of subdural effusion and treat them with brain imaging test on time.

Research progress in subdural effusion after decompressive craniectomy of severe traumatic brain injury

Research progress in subdural effusion after decompressive craniectomy of severe traumatic brain injury

Organized Chronic Subdural Hematoma Following Ventriculoperitoneal Shunt: A Case Report

Subdural Hematoma (SDH) or effusion following Ventriculoperitoneal (VP) shunt for hydrocephalous is not an unusual complication. However, we rarely come across organized chronic subdural hematoma (CSDH) following shunts. We present a case of organized CSDH in a four-year-old female child who presented with seizure three and half year after the VP Shunt placement for obstructive hydrocephalus due to aqueductal stenosis. The child was managed with craniotomy and evacuation of hematoma with membranectomy. We report this unusual case and review the relevent literature.Nepal Journal of Neuroscience 12:46-48, 2015

Giant Choroid plexus papilloma in a child: A Case Report

Tumors of the choroid plexus are rare neoplasms of neuroectodermal origin, accounting for less than 1% of all intracranial tumors. We report a case of giant choroid plexus papilloma of the lateral ventricle extending into the third ventricle of a 3 years old female child. She presented with features of obstructive hydrocephalus and had undergone V-P shunt at the age 3months. She repeatedly underwent revision of the V-P shunt at the age of 6 months, 22 months and 36 months prior to the tumor excision. An anterior interhemispheric, transcallosal approach was performed and total excision was achieved with fenestration of lamina terminalis at the age of 37 months. Following the surgery the patient developed bilateral subdural effusion requiring bilateral subdural-peritoneal shunt and the nonfunctional V-P shunt was removed. Histological evaluation confirmed the diagnosis of the choroid plexus papilloma.Nepal Journal of Neuroscience 13:57-59, 2016

Meta-analysis of surgical treatment and non-operative treatment for traumatic subdural effusion in adults

Objective To compare the efficacy and prognosis between surgical treatment and non-operative treatment for traumatic subdural effusion (TSE) adult in adults. Methods Wanfang data, VIP database, CNKI, PubMed, EMBase, Cochrane were searched for the relevant papers published between 1985 and 2015. According to the inclusion and exclusion criteria, quality of the papers enrolled was evaluated using the Jadad scale and Newcastle-Ottawa Scale (NOS). RevMan 5.2 software was used to have a meta-analysis on the extracted data between operation group and non-operation group in recent cure rate, short-term effective rate, recent inefficiency, recent chronic subdural hematoma (CSDH) incidence, early mortality, long-term cure rate and long-term CSDH incidence, and bias analysis of the results was conducted. Results Nine papers with a total of 824 patients were enrolled in this meta-analysis. There were no significant differences between the two groups with respect to recent cure rate (OR=2.39, 95%CI 0.72~7.88, P>0.05), recent inefficiency(OR=0.85, 95%CI 0.12-6.01, P>0.05), recent CSDH incidence (OR=0.79, 95%CI 0.35-1.76, P>0.05) and early mortality (OR=2.88, 95%CI 0.13-61.55, P>0.05). Between-group differences were significant in short-term effective rate (OR=0.20, 95%CI 0.06-0.64, P<0.01), long-term cure rate (OR=0.32, 95%CI 0.14-0.71, P<0.01), long-term CSDH incidence(OR=3.14, 95%CI 1.42-6.97, P<0.01). Bias analysis showed no publication bias in the long-term outcome of the enrolled papers. Conclusion For TSE patients, surgical treatment exhibits significantly better results in recent effective rate, long-term cure rate and long-term CSDH incidence than non-operative treatment. Key words: Subdural effusion, traumatic; Brain injuries; Meta-analysis

Spontaneous intracranial hypotension in Graves’ disease

Autoimmune thyroid disorders such as hyperthyroidism and hypothyroidism are rare causes of intracranial pressure alterations. We present a case of spontaneous intracranial hypotension associated with Graves’ disease which was not reported previously in the literature. A 42-year-old woman was admitted to our institution because of a sudden developed headache, neck pain, nausea and vomiting. The headache was severe during standing and walking but improved within 15 to 30 minutes after lying down. Thyroid gland was grade 1b diffuse palpable and other physical examinations were normal. Autoimmune hyperthyroidism was diagnosed according to laboratory results. Gadolinium-enhanced magnetic resonance imaging revealed a hyperintensity that is consistent with thickened dura and subdural effusion. The patient was managed with bed rest, hydration, methimazole, methyl-prednisolone 16 mg/day of three days and then tapered gradually. After these medications the headache resolved. It should be kept in mind that encephalopathy associated autoimmune thyroid disease may be related with spontaneous intracranial hypotension.

Effective treatment via early cranioplasty for intractable contralateral subdural effusion after standard decompressive craniectomy in patients with severe traumatic brain injury

ObjectiveThis 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. MethodsA retrospective analysis was performed in 13 patients with severe traumatic craniocerebral injury showing complicated intractable contralateral subdural effusion after standard decompressive craniectomy, in whom satisfactory results were not obtained from treatments, including compression bandaging, head-down bed rest (HDBR), continuing lumbar drainage, and Ommaya catheter drainage. Among these patients, 6 underwent temporal muscle sticking, while 7 underwent early cranioplasty. The postoperative changes in the subdural effusion were observed. ResultsIn the 6 patients who underwent temporal muscle sticking and the 7 who underwent early cranioplasty, the subdural effusion completely resolved or was significantly reduced within one month, and no recurrence was observed in the 6-month follow-up period. However, secondary bilateral cranioplasty was still necessary in the postoperative 3–6 months for the patients who underwent temporal muscle sticking. In the early cranioplasty group, there were three total operations, and the average length of stay (ALOS) was 76days. In the temporal muscle sticking group, there were four total operations, and the ALOS was 56.1days. A retrospective analysis of surgical pain showed that 100% of the patients in the first group experienced unacceptable suffering, while 14.3% of the patients in the second group experienced pain. ConclusionEarly cranioplasty is an effective, economical, and less painful treatment for intractable contralateral subdural effusion after standard decompressive craniectomy.

Risk factors for hydrocephalus after moderate to severe traumatic brain injury

Objective To investigate the risk factors of posttraumatic hydrocephalus (PTH) in patients with moderate to severe traumatic brain injury (TBI). Methods Aretrospective study was conducted for 183 patients with moderate to severe TBI (125 males, 58 females; 6-91 years of age, mean 48.23 years). According the presence of PTH, the patients were allocated into PTH group (n=34) and non-PTH group (n=149). Risk factors of PTH were assessed by univariate and logistic regression analysis, including gender, age, injury types, injury severity, intraventricular hemorrhage, subarachnoid hemorrhage, midline shift, subdural effusion, therapeutic strategies and skull defect. Association between the boundaries of skull defect and PTH was determined. Results Between-group differences were not significant regarding age, gender, injury types and intraventricular hemorrhage (P>0.05), but differed significantly in injury severity, subarachnoid hemorrhage, midline shift, subdural effusion, craniectomy and skull defect (P<0.05). Further Logistic regression analysis confirmed subarachnoid hemorrhage(OR=6.169), interhemispheric subdural effusion(OR=31.743), and unilateral (OR=17.602)and bilateral(OR=30.567)skull defects were risk factors of PTH. Of the patients with unilateral skull defect following decompressive craniectomy, the inferior limit ≤10 mm from the zygomatic arch also played a role in the development of PTH (OR=5.500, P<0.05). Conclusions Subarachnoid hemorrhage, interhemispheric subdural effusion and skull defect are risk factors of PTH. Unilateral skull defects with the inferior limit too close to the zygomatic arch can predispose to the development of PTH. Key words: Hydrocephalus; Risk factors; Decompression, surgical; Subdural effusion

Spontaneous intracranial hypotension complicated with cerebral venous thrombosis and subdural effusion: a case report

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