Subdural Hygroma Research Articles

Asymptomatic spinal subdural epiarachnoid hygroma after lumbar laminectomy for lumbar spinal canal stenosis: illustrative case.

BACKGROUNDSpinal subdural epiarachnoid hygroma (SSEH) after lumbar laminectomy is an extremely rare complication.OBSERVATIONSAn 84-year-old man presented to the hospital with lower back pain, radicular pain, and numbness in the lateral aspect of the left leg. Magnetic resonance imaging (MRI) revealed anterior lumbar spondylolisthesis at L3, severe disc herniation at L3–4, and severe lumbar spinal canal stenosis at L3–4 and L4–5. Lumbar laminectomy at L3–4 and L4–5 and discectomy at L3–4 were performed without complications such as cerebrospinal fluid (CSF) leakage and durotomy intraoperatively. Although lower back pain and numbness at the lateral aspect of the left leg were resolved postoperatively, postoperative MRI showed spinal nerve deviation to the ventral side due to SSEH from T12 to S1. Conservative therapy was performed for asymptomatic SSEH, and MRI 1 week postoperatively indicated improved ventral spinal nerve deviation and reduced SSEH.LESSONSSSEHs after posterior decompression without durotomy are extremely rare. Asymptomatic SSEHs may resolve with conservative treatment. However, surgery should be performed to decompress hygroma in patients with symptomatic SSEH.

FLOATING ANCHORED DECOMPRESSIVE CRANIECTOMY IN PATIENTS WITH TRAUMATIC BRAIN INJURY: A CASE SERIES

Introduction:Raised intra cranial pressure following traumatic brain injury have been managed classically with a decompressive craniectomy (DC). However the survivor of DC has a lot more in his hand other than the nancial burden and his own disability. Some of these complications like subdural hygroma, syndrome of trephined and the need for subsequent cranioplasty can be reduced by the means of oating anchored DC. Aim and objective:To design a novel method of decreasing ICP in traumatic brain injury patients and prevent the need for subsequent cranioplasty. Materials and method We did a case series of oating anchored decompressive craniectomy in 25 patients. Patients were selected based on CT criteria and clinical detoriation. Midline shift of >5 mm, effacement of basal cisterns, blood volume of >25ml and fall in the GCS by more than two points or GCS <8 were selected for the study. Patients were evaluated based on Radiological improvement like improvement in the mid-line shift, opening up of cisterns, Glasgow outcome scale (GOS) at the time of discharge, Length of stay (LOS) & Mortality rate. Results and observation: A total of 25 cases were operated, of which 19 cases had acute SDH, 4 cases had acute SDH with multiple haemorrhagic contusions and 2 cases had traumatic ICH (Intracerebral Haemorrhage). Overall mortality rate was 36%, LOS was 12.4 days and GOS at time of discharge was 2.76. Conclusion: The surgical technique is good in reducing the ICP in traumatic brain injury cases. However this cannot be applied to all cases. Patients with only acute sdh without multiple haemorrhagic contusions are the better candidates. Still further study is required so as to come up with preoperative criteria so that patient selection for oating anchored decompressive craniectomy can be better.

Management of subdural hygroma in infants and children

Management of subdural hygroma in infants and children

Microsurgical Management of Complex Hypothalamic Hamartomas in the Era of Minimally Invasive Therapy: A Case Series and Narrative Review

There has been a paradigm shift in the management of hypothalamic hamartoma (HH) from traditional microsurgical techniques to less invasive alternatives. However, large and extensive HH may fail to respond to these therapies, necessitating craniotomies. All patients who underwent microsurgical resection of a complex HH by the 2 senior authors from 2011 to 2021 were included. Charts were retrospectively reviewed and demographic, clinical, imaging, and outcome data were recorded. Eight patients (mean age, 7 years) were included. Two had failed previous treatments. All 7 presented with gelastic seizures and cognitive dysfunction, 6 showed central precocious puberty, and 3 had behavioral problems. The mean lesion size was 21.6 mm and all had interpeduncular extension, 5 had intraventricular extension (Delalande type I, 3; type III, 4; type IV, 1). A frontotemporal orbitozygomatic approach with optic nerve decompression was used in all patients, supplemented by another approach in 3 (endoscopic transventricular, 3; transcallosal, 1). Gross total resection was achieved in 6 patients and subtotal resection in 2. Transient complications occurred in 3 patients (37.5%): self-limited sodium imbalance (n= 3), subdural hygroma (n= 2). Permanent complications occurred in 2 patients (25%): perforator infarct (n= 1) and short-term memory loss (n= 1). All patients experienced seizure resolution with preserved hypothalamic-pituitary axis function. After a mean follow-up of 41 months (range, 2-66 months), 7 patients remained seizure free, and 1 had rare seizures. Cognitive and behavioral symptoms improved in all patients. For large HH with interpeduncular extension, microsurgery via the frontotemporal orbitozygomatic approach is a safe and highly effective treatment modality.

Diabetic ketoacidosis (DKA) induced cerebral edema complicating small chronic subdural hematoma/hygroma/ at Zewuditu memorial hospital: a case report

BackgroundWhile both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors’ best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma.Case summaryThis study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA’s medical treatment.ConclusionDKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.

Factors Associated With Subdural Hygroma Following Mild Traumatic Brain Injury.

Subdural hygroma (SDG) is a complication of traumatic brain injury (TBI). In particular, the outcome and outpatient treatment period may vary depending on the occurrence of SDG. However, the pathogenesis of SDG has not been fully elucidated. Therefore, this study aimed to identify the risk factors associated with the occurrence of SDG after mild TBI. We retrospectively analyzed 250 patients with mild TBI admitted to a single institution between January 2021 and December 2021. The SDG occurrence and control groups were analyzed according to the risk factors of SDG, such as age, history, initial computed tomography (CT) findings, and initial laboratory findings. The overall occurrence rate of SDG was 31.6% (n=79). A statistically significant association was found between preoperative diagnoses and the occurrence of SDG, such as subarachnoid hemorrhage (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.26-4.39) and basal skull fracture (OR, 0.32; 95% CI, 0.12-0.83). Additionally, age ≥70 years (OR, 3.20; 95% CI, 1.74-5.87) and the use of tranexamic acid (OR, 2.12; 95% CI, 1.05-4.54) were statistically significant factors. The prognostic evaluation of patients using the Glasgow Outcome Scale (GOS) did not show any statistical differences between patients with and without SDG. SDG was not associated with the prognosis of patients assessed using the GOS. However, depending on the occurrence of SDG, differences in patient symptoms may occur after mild TBI. Therefore, the early evaluation of patients with mild TBI and determination of the probability of developing SDG are important.

Nomogram for predicting post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury.

This study aimed to develop and validate a practical nomogram to predict the occurrence of post-traumatic hydrocephalus in patients who have undergone decompressive craniectomy for traumatic brain injury. A total of 516 cases were enrolled and divided into the training (n=364) and validation (n=152) cohorts. Optimal predictors were selected through least absolute shrinkage and selection operator regression analysis of the training cohort then used to develop a nomogram. Receiver operating characteristic, calibration plot, and decision curve analysis, respectively, were used to evaluate the discrimination, fitting performance, and clinical utility of the resulting nomogram in the validation cohort. Preoperative subarachnoid hemorrhage Fisher grade, type of decompressive craniectomy, transcalvarial herniation volume, subdural hygroma, and functional outcome were all identified as predictors and included in the predicting model. The nomogram exhibited good discrimination in the validation cohort and had an area under the receiver operating characteristic curve of 0.80 (95%CI 0.72-0.88). The calibration plot demonstrated goodness-of-fit between the nomogram's prediction and actual observation in the validation cohort. Finally, decision curve analysis indicated significant clinical adaptability. The present study developed and validated a model to predict post-traumatic hydrocephalus. The nomogram that had good discrimination, calibration, and clinical practicality can be useful for screening patients at a high risk of post-traumatic hydrocephalus. The nomogram can also be used in clinical practice to develop better therapeutic strategies.

Endoscopic Management of Intracranial Arachnoid Cysts: A Retrospective Study

Introduction: Endoscopic method is an alternative to shunt placement and open surgery; it creates a communication between cyst, ventricular system and subarachnoid system. Aim: To describe the demographic, clinical profile, operative technique, complications and outcome following endoscopic management of intracranial arachnoid cysts at a tertiary Care Hospital in Southern India. Materials and Methods: A retrospective observational study was conducted in tertiary care hospital in southern India in which case records of all 42 symptomatic patients diagnosed with intracranial arachnoid cyst and who underwent surgical management by endoscopic techniques from 1995 to 2010 were included. Demographics, clinical presentations, type of surgery, complications and clinical outcome were recorded and results were expressed in terms of frequency and percentages. Results: Study included 30 males and 12 females with a mean (SD) age of 14.8 (15.5) years. The most common presenting feature was raised intracranial pressure (27.6%). Cysts were commonly located inposteriorfossa(35.7%)followedbyintraventricularregion(31.0%). All patients (100%) underwent endoscopic fenestration with either cystoventriculostomy or cystocisternostomy. Endoscopic Third Ventriculostomy (ETV) was done in 21.4% of patients associated with hydrocephalus. Postoperative complications (11.9%) included Cerebrospinal Fluid (CSF) leak, subdural hygroma and metabolic complications. Mortality rate was 2.4%. Follow-up period ranged between one month to 99 months (median 24 months). Success rate of the procedure was 95%. Conclusion: Prevalence of intracranial arachnoid cyst is common in males and is often located in the posterior fossa. The endoscopic management of intracranial arachnoid cyst is safe and is associated with superior clinical outcome

Abstract- Poster

1)Subdural hygromas are fluid collections within the subdural space that are clear or only slightly xanthochromic or blood tinged. They can be caused by mechanical trauma, meningeal or parameningeal infection, or venous congestion. Common presentation of SDH are fever, headache, nausea,vomiting, confusion.2)Here we report a 48 year old male who came with complaints of aggressiveness, forgetfulness, disturbed sleep. Further patient started developing dysarthria,inattention and memory was impaired.3)Neuroimaging- MRI brain showed subdural hygroma in bilateral fronto temporal parieto occipital region.4)Neurosurgery opinion obtained which is unremarkable5)Patient then started regaining his verbal fluency,memory and aggression settled in a span of 3 weeks.Although SDH is common among 1/3rd of patients with head injury/trauma,it is very rare that SDH presents with such features.References 1) SUBDURAL HYGROMA PRESENTING AS DEMENTIA WITH KLUVER-BUCY SYMPTOMS HARPREET S. DUGGAL, CHRISTODAY R.J.KHESS & S. HAQUE NIZAMIE2) Cognitive Impairment in the Elderly with Chronic Subdural Hematoma Hyun Hee Ye, MD, Jeong Ho Kim, MD, Yoon Suk Kim, MD,

Neurological Involvement in Malignant Atrophic Papulosis: A Comprehensive Review of Literature.

Malignant atrophic papulosis (MAP), or systemic Degos disease, is an obliterative vasculopathy of unknown origin, characterized by erythematous papules found on the skin, central nervous system (Neuro-MAP) and gastrointestinal tract. Neurological involvement occurs in approximately 20% of systemic cases, is progressive and largely fatal. It can be described in two forms: 1) the parenchymal presenting with meningoencephalitis and meningomyelitis and 2) the neurovascular presenting with large cerebral infarcts, intracranial and subarachnoid hemorrhage, subdural hematoma and venous sinus thrombosis. Predilection to subdural hematoma or hygroma is characteristic for neurological involvement in MAP in comparison to other vasculpathies and vasculitides. Peripheral nervous system manifestations are less common and include polyradiculopathy, neuropathy, and myopathy. CSF analysis usually shows mild to moderate pleocytosis, increased protein content, and normal glucose. Brain MRI may reveal cortical, subcortical and deep white matter ischemic lesions with possible nodular, leptomeningeal, dural, or ependymal enhancement. Spinal cord MRI may reveal patchy lesions from the periphery to the center or cord atrophy in progressive course. Neurological involvement in MAP has a grave prognosis. The interval from onset of papulosis to death averages two years in patients with neurological involvement. There is no confirmed treatment for MAP but there are promising reports with eculizumab and treprostinil.

Abusive head trauma. A review of our experience

Abusive head trauma (AHT) is defined as an injury to the skull or intracranial contents due to inflicted blunt impact and/or shaking. It is characterized by the triad: encephalopathy, retinal haemorrhages and subdural hematoma. The main objective is to know the epidemiological, clinical and radiological characteristics; as well as the short and long term outcomes of patients diagnosed with AHT. It is a descriptive, observational and retrospective study of the 19 patients diagnosed with AHT at a tertiary hospital from 1990 to 2018, both included. The mean age of the patients was 5,5 months with parity between both sexes. The principal medical histories reported were: absence of trauma (n = 9), history of a short fall (n = 6) and shaking (n = 4). The most frequent initial presentation was severe, and seizures was the main symptom (n = 8). Retinal haemorrhages were present in fifteen patients and subdural hematoma or hygroma in fifteen patients. Two patients died, seven presented short-term outcomes, and ten of the twelve patients who were performed a follow-up presented long-term outcomes. These outcomes were manifested as cognitive or behavioural disorders (n = 5) or as neurological disorders (n = 6). The epidemiological, clinical and radiological characteristics found are very similar to those reported in the literature. The prevalence of outcomes is high and they appear as cognitive or behavioural disorders.

Abstract- Poster

INTRODUCTION.§ Frontotemporal dementia (FTD) refers to a group of dementias characterized by degeneration in the frontal and temporal lobes of the brain. Rates of early-onset FTD are high with 13% of individuals with FTD being under the age of 50.§ Younger cases of FTD tend to exhibit frequent abrupt mood changes, increased aggression, behavioral disinhibition, lack of empathy, and deficits in working memory.There are three clinical presentations of FTD: behavioral variant (bvFTD) and two forms of primary progressive aphasia.Here we report a a 37 yr Old married man was brought with complaints of a progressive history of changes in behaviour and personality.The patient was in good baseline health until age 35 years, when his family noticed an increase in change in behavior with history of cannabis smoking for 2 yrs, H/O multiple extra marital affairs for 2 yrs,with H/O restlessness,dull and withdrawn, sleep disturbance,poor self care, refusing to eat properly, slowly not speaking to anyone, poor work performance for the past 6 months. He was diagnosed as a case of substance induced psychosis with catatonic features and treated. Again after three months pt presented to psychiatric opd with complaints of restlessness, speech difficulty forgetting things, inappropriate laugh,disinterest in daily activities, walking in the house all the time, disinhibited behaviour,weight loss,excessive craving for tobacco,putting inedible things at mouth all these symptoms for one month.On Mse O/E he was alert,ambulant,kempt,yawning frequently during interview, not cooperative, sits in chair and gets up frequently, no Spontaneous speech. He did not attempt to initiate conversation, answering questions with short, terse responses. relevant replies. He often gazed with a prolonged, fixed stare and exhibited motor stereotypies such as clapping his thighs or tapping his feet vigorously.— There were no upper or lower motor neurone signs, frontal release signs positive, and no parkinsonism or limb apraxia. His gait was normal. He scored only 55 out of 100 on the Addenbrooke’s Cognitive Examination-III, with impairments across domains but with particularly poor executive function (naming only two words beginning with P in a minute, and only 10 animals over a minute, leading to a very low verbal fluency score of 4 out of 14). Attention (score 12 out of 18), language (19 out of 26), memory (9 out of 26) and visuospatial (11 out of 16) abilities were also affected.— Further neuropsychological testing identified a global reduction in general intellectual function, with severe executive function deficits as well as poor verbal working— Neurology opinion obtained as a case of young onset FTD— MRI scan of the brain showed substantial bilateral, symmetrical frontal atrophy, with no evidence of white matter changes that would be typical of a vascular, vasculitic or inflammatory cause (figure 1). In addition, autoimmune encephalitis was negative; and HIV and syphilis serology were all normal or negative. Cerebrospinal fluid (CSF) contained no white cells or abnormal cells and therefore no evidence of an active inflammatory, infective or malignant process; the CSF protein concentration was also normal. PET scan suggestive of FTDReference 1. Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 2011;134:2456?77.2. Lebert F, Stekke W, Hasenbroekx C, et al. Frontotemporal dementia: a randomised, controlled trial with trazodone. Dement Geriatr Cogn Disord 2004;17:355?9.3. Warren JD, Rohrer JD, Rossor MN. Clinical review. Frontotemporal dementia. BMJ 2013;347:f4827.4. Neumann M, Mackenzie IRA. Review: Neuropathology of non-tau frontotemporal lobar degeneration. Neuropathol Appl Neurobiol 2019;45:19?40.5. Mann DMA, Snowden JS. Frontotemporal lobar degeneration: pathogenesis, pathology and pathways to phenotype. Brain Pathol 2017;27:723?36. Ct brain showed bilateral frontoparietotemporal Subdural HYGROMA.Neurologist opinion obtained. There was no focal neurological defecit and conservative management suggested. Patient was treated with tab risperidone 2mg 1-0-1 tab sodium valproate 200 mg 1-1-1, tab diazepam 5mg 0-0-1, her symptom improved with treatment (ymrs-12.)

Öncesinde Asemptomatik Olan Subdural Higroma İle Seyreden Spontan Araknoid Kist Rüptürü: Olgu Sunumu

Aim: Spontaneous rupture of an arachnoid cyst resulting in a subdural hygroma is an infrequent event. We report an adult patient who had no previous neuroimaging and had acute onset headache, dizziness, and nausea unrelated to trauma.
 
 Case: A 67-year-old male patient was brought to the emergency service complaints of sudden onset of dizziness, headache, and vomiting while working in the garden. He described ongoing nausea and headache localized to the frontal region. Brain CT imaging was planned for the patient whose nausea and dizziness worsened while his symptomatic treatment continued. In the brain CT, a large hypodense extracerebral collection was detected in the area starting from the middle fossa in the right cerebral hemisphere and extending to the convexity level in the frontoparietal region. The patient was consulted in the neurosurgery unit. Surgical intervention was not considered, and the patient was admitted to the neurosurgery service for treatment. Due to the asymptomatic course in the service follow-ups, he was discharged with outpatient clinic control recommendations.
 
 Conclusion: This case illustrates the importance of recognizing the possibility of spontaneous rupture of an arachnoid cyst. This phenomenon should be considered as a differential diagnosis in patients without head trauma. Although it is rare, being aware of such a case is helpful in preventing possible bad outcomes.

Post Traumatic Hydrocephalus: Incidence, Pathophysiology and Outcomes.

Post-traumatic hydrocephalus (PTH) is a sequel of traumatic brain injury (TBI) that is seen more often in patients undergoing decompressive craniectomy (DC). It is associated with prolonged hospital stay and unfavorable outcomes. To study the incidence and risk factors for development of PTH in patients undergoing DC in our institution and to review the literature on PTH with respect to incidence, risk factors, pathophysiology, and outcomes of management. Data from 95 patients (among 220 patients who underwent DC for TBI and fulfilled the inclusion criteria) over a 5-year period at Christian Medical College, Vellore were collected and analyzed to study the incidence and possible risk factors for development of PTH. A review of the literature on PTH was performed by searching PUBMED resources. Thirty (31.6%) out of 95 patients developed post-traumatic ventriculomegaly, of whom seven (7.3%) developed symptomatic PTH, necessitating placement of ventriculoperitoneal shunt (VPS). No risk factor for development of PTH could be identified. The reported incidence of PTH in the literature is from 0.07% to 29%, with patients undergoing DC having a higher incidence. Younger age, subarachnoid hemorrhage, severity of TBI, presence of subdural hygroma, and delayed cranioplasty after DC are the main risk factors reported in the literature. PTH occurs in a significant proportion of patients with TBI and can lead to unfavorable outcomes. PTH has to be distinguished from asymptomatic ventriculomegaly as early as possible so that a CSF diversion procedure can be planned early during development of PTH.

Ruptured middle cranial fossa arachnoid cysts after minor trauma in adolescent boys presenting with subdural hygroma: two case reports

BackgroundIntracranial arachnoid cysts are common, cerebrospinal fluid-filled, innocent lesions that are usually detected incidentally on brain imaging. They may rupture and complicate due to subdural hematoma or hygroma after minor trauma.Case summaryAuthors present two cases of ruptured middle cranial fossa arachnoid cysts in adolescent (12-year-old and 15-year-old) Afghan boys presenting with subdural hygroma after minor trauma.ConclusionImaging work-up is necessary for symptomatic patients following minor head trauma as incidentally detected ruptured intracranial arachnoid cysts can be responsible for the symptoms.

Contralateral subdural effusion after decompressive craniectomy: What is the optimal treatment?

ObjectiveContralateral subdural effusion after decompressive craniectomy (CSEDC) is rare, and the optimal treatment is not determined. We present 11 cases of CSEDC and give an overview of the English literature pertaining to this disease. MethodsWe searched the database at our institution and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows (single word or combination): “subdural hygroma”; “subdural effusion”; “decompressive craniectomy”. Only patients with CSEDC and contained adequate clinical information pertinent to the analysis were included. Results11 cases of CSEDC were recorded at our institution. They comprised ten men and one woman with an average age of 41.9 years. All the 8 symptomatic patients underwent surgery and the CSEDC resolved gradually. 68 cases of CSEDC were found in the literature. Including ours, a total of 79 patients were analyzed. Conservative treatment was effective in the asymptomatic patients. 41.7% of the symptomatic CSEDC underwent burr hole drainage and successfully drained the CSEDC. However, 76% of them received subsequent surgery to manage the reaccumulation of CSEDC. 25% of the symptomatic patients underwent cranioplasty, while 13.3% of them received Ommaya drainage later because of CSEDC recurrence. 18.3% of the symptomatic patients underwent cranioplasty plus subduroperitoneal shunting, and all CSEDC resolved completely. ConclusionsBurr hole drainage appears to be only a temporary measure. Early cranioplasty should be performed for patients with CSEDC. CSF shunting procedures may be required for patients in whom CSEDC have not been solved or hydrocephalus manifest after cranioplasty.

Endoscopic management of periventricular and intraventricular arachnoid cysts

IntroductionThe most successful surgical management of periventricular and intraventricular cysts is still a matter of debate. Up to the early 1990s, open cyst fenestration and cystoperitoneal shunts were the only options available. Recently, different endoscopic approaches to these lesions have gained popularity.MethodsEighteen endoscopic procedures were performed for the treatment of arachnoid cysts in 18 patients. Sylvian fissure arachnoid cysts were excluded from this study. Ten of them were females and eight were males with their ages ranging from 6 months to 50 years with a mean of 16 years. All patients were prospectively observed.ResultsSeven of the arachnoid cysts were in the suprasellar region, 5 in the quadrigeminal region, 2 in the posterior fossa, 2 parietal, and 2 intraventricular. Seventeen cases (94%) had hydrocephalus. The main presenting manifestations were those of increased intracranial pressure. All fenestrations were done in the lateral ventricle except for the 2 cases with posterior fossa arachnoid cysts, the fenestrations were done to the fourth ventricle. Endoscopic ventriculocytostomies (VC) were performed in 14 cases without operative complications and no stents were placed. Endoscopic cystocisternostomies (C) were done in all suprasellar cases. Endoscopic cystoventriculostomies (CV) were done in 4 cases. The mean surgical time was 1 h. The mean follow-up period was 15 months. Symptoms improved in 17 cases. Seventeen cases demonstrated a significant decrease of the cysts’ size in the postoperative computed tomography (CT) and magnetic resonance imaging (MRI). A single case developed a complication in the form of subdural hygroma which required no intervention and was managed conservatively.ConclusionEndoscopic management of periventricular and intraventricular arachnoid cysts is a useful safe option in the management of arachnoid cysts related to the ventricular system.

Subdural Hygroma- A Case Report

Introduction: An accumulation of Cerebrospinal fluid in subdural spaces is known as subdural hygroma. It is encountered in all age-groups but overall, most common in elderly. The exact pathogenesis of Subdural Hygroma is still unclear.
 Presentation of Case: A 03 months old female child was brought to Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India on date 02/10/2020 with the complaints of breathing difficulty, elevated body temperature, excessive enlargement of head with bulged and tense fontanel, high pitch shrill cry, restlessness, nausea and vomiting. On physical examination, it is found that head circumference was 44 cm, head size was enlarged, bulged anterior fontanel, angular cheilitis, pale conjunctiva as well as peripheral cyanosis were present. The child was diagnosed at birth and child was brought to Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha for surgical management of subdural hygroma.
 Intervention: The treatment of patients was started immediately after admission.Burr-Hole Evacuation was done on 4th October 2020 and the patient was discharged on 08th October 2020. 
 Conclusion: In this report, we mainly focus on expert surgical management and excellent nursing care helped in managing the complicated case very nicely. The patient response was positive to conservative and nursing management. The patient was discharged without postoperative complications and satisfactory with recovery.

Post-traumatic hydrocephalus – incidence, risk factors, treatment, and clinical outcome

Objectives Post-traumatic hydrocephalus (PTH) is well-known after traumatic brain injury (TBI), but there is limited evidence regarding patient selection for ventriculo-peritoneal (VP)-shunt treatment. In this study, we investigated the incidence and risk factors for PTH and the indication for and outcome after shunt treatment. Materials and methods In this retrospective study, 836 TBI patients, treated at our neurointensive care (NIC) unit at Uppsala university hospital, Sweden, between 2008 and 2018, were included. Demography, admission status, radiology, treatments, and outcome variables were evaluated. Results Post-traumatic ventriculomegaly occurred in 46% of all patients at NIC discharge. Twenty-nine (3.5%) patients received a VP-shunt. Lower GCS M at admission, greater amount of subarachnoid hemorrhage, meningitis, decompressive craniectomy (DC), and ventriculomegaly at NIC discharge were risk factors for receiving a VP-shunt. Fourteen of the PTH patients showed impeded recovery or low-pressure hydrocephalus symptoms, of whom 13 experienced subjective clinical improvement after shunt treatment. Five PTH patients showed deterioration in consciousness, of whom four improved following shunt treatment. Five DC patients received a shunt due to subdural hygromas (n =2) or external brain herniation (n = 3), of whom two patients improved following treatment. Five patients were vegetative with concurrent ventriculomegaly and these patients did not have any positive shunt response. Altogether, 19 (66%) PTH patients improved after shunt surgery. Conclusion Post-traumatic ventriculomegaly was common, but few developed symptomatic PTH and received a VP-shunt. Patients with low-pressure hydrocephalus symptoms had the best shunt response, whereas patients with suspected vegetative state exhibited a minimal shunt response.

Chronic Subdural Hygroma in Battered Baby.

The battered baby syndrome is a condition in which a child is seriously physically abused by thecaregiver or parents. The World Health Organization (WHO) estimates 40 million children aresubjected to abuse and neglect around the world. Most of the industrialized countries have theirreporting and surveillance system and data on child battery but in developing countries includingIndia, there is a lack of data regarding the extent of child battering that takes place within thehouseholds or institutions. India published a report on one of the largest surveys done on childabuse and found that two out of every three children were physically abused and 88.6% of themsuffered at the hands of their parents. Unfortunately, the methodology restricted the study to onlyolder children who could give a history of abuse. Therefore, the magnitude of the problem given onlyhighlights among children above the age of 5 years. [1]. we are reporting a case of an Infant withFebrile encephalopathy, detailed examination and investigation found out a case of chronic SubduralHygroma with classical neuroimaging features of Abusive trauma. We have done a multidisciplinaryapproach with a Neurosurgeon, a social worker who treated the child with burr hole surgery forsubdural hygroma & the child recovered with consciousness. This case is Special because a 5-monthMale infant was subjected to abuse due to a psychological problem in a Family Member, suspicionwas lacking as males are unlikely to undergo gender-biased in India and Early age of presentation.