441 results on '"Subdural Effusion"'
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2. 만성 경막하혈종의 발병기전 및 역학.
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Lee, Kyeong-Seok
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INJURY complications ,SEX distribution ,BRAIN ,AGE distribution ,CHRONIC diseases ,SUBDURAL hematoma - Abstract
Background: Chronic subdural hematoma (SDH) is a common condition encountered in neurosurgical practice; however, its pathogenesis remains controversial. Current Concepts: SDH refers to blood accumulation inside the dura and is classified into acute, subacute, and chronic types. Histopathologically, acute SDH shows no neomembrane formation and the hematoma is a clot, in contrast to chronic SDH characterized by a neomembrane surrounding the liquefied hematoma. SDH is usually categorized into acute and chronic types, with subacute SDH being more similar to chronic SDH. Posttraumatic subdural lesions include acute and chronic SDH, subdural hygroma (SDG), or effusion. SDG is a blood-tinged fluid accompanied by neomembrane formation in some cases. These lesions are pathologically different from each other but may change depending on the situation. Discussion and Conclusion: Chronic SDH mainly originates from an SDG and acute SDH. SDG is usually triggered by trauma but only occurs in patients in whom sufficient potential space is available and may occur spontaneously in such cases. Therefore, SDG frequently occurs in children and in elderly patients, in men with a larger skull size, and on the left side of the body, which usually shows a wider hemisphere. Separation of the dural border cell layer causes inflammation, indicated by fibroblast proliferation and neovascularization. Conversion of an SDG into a chronic SDH or enlargement of a chronic SDH is attributable to formation of neomembranes, neovascularization, and repeated microhemorrhages from fragile capillaries. Chronic SDH is treated with removal of the hematoma to relieve the mass effect and embolization of the feeding artery for the bleeder. Outcomes of chronic SDH depend on the absorptive-expansion capacity dynamics. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Clinical analysis of hyperbaric oxygen combined with subdural drilling and drainage in the management of subdural effusion type IV with intracranial infection in infant patients.
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Liuyin Chen, Yanke Yue, Pengyuan Luo, Yi Qu, Jiangshun Fang, Chaojun Xin, Lige Lv, Jimei Luan, Zhenghai Cheng, Zhiguo Yang, and Yaning Sun
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EXUDATES & transudates ,INFANTS ,DRAINAGE ,INFECTION control ,OXYGEN ,INTRA-abdominal hypertension - Abstract
Background: To explore the therapeutic effect of hyperbaric oxygen combined with subdural drilling and drainage (SDD) on subdural effusion type IV with intracranial infection in infant patients. Methods: This retrospective controlled study included 328 infant patients with subdural effusion type 4 with intracranial infection between January 2005 and January 2023. 178 patients were treated by hyperbaric oxygen combined with SDD (group A). 142 cases were treated with SDD (group B). 97 infants were only received hyperbaric oxygen (group C). Clinical outcomes, the control time of intracranial infection, complications, and the degree of brain re-expansion after 6 months of treatment were compared among the three groups. According to the comprehensive evaluation of treatment effectiveness and imaging results, it is divided into four levels: cured, significantly effective, improved, and ineffective. Results: No patient died during follow-up. The three groups were similar regarding age, sex, the general information, and clinical symptoms (p>0.05). All intracranial infections in the children were effectively controlled. There was no difference in infection control time between group A and group B, and there was no statistical significance. However, the control time of intracranial infection between the two groups was different from that of group C, which was statistically significant. Compared with group B and group C, the degree of brain re-expansion in group A has obvious advantages and significant differences. The effective rates of the three groups were 83.7%, 58.5%, and 56.7%, respectively. There were 28 cases of subcutaneous hydrops in group A and 22 cases of subcutaneous hydrops in group B after operation, and no other serious complications. Conclusion: The SDD is safe and effective for infant patients with intracranial infections through fluid replacement and intrathecal antibacterial. Hyperbaric oxygen is effective as an adjuvant therapy to promote brain re-expansion. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Spontaneous subdural effusion in a hospitalized Covid-19 patient: Case report
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Artur Eduardo Martio, Ana Luisa dos Santos Carregosa, Octávio Ruschel Karam, Wagner Lazaretto Padua, and Paulo Moacir Mesquita Filho
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Covid-19 ,Subdural effusion ,Neurologic manifestations ,Neurophysiology and neuropsychology ,QP351-495 - Abstract
Subdural effusions (SE) have already been associated with several viruses, but there are few associations with Covid-19 reported to date, and all of them had one thing in common: the presence of superimposed bacterial rhinosinusitis. Here we describe the case of a 76-year-old male patient that was transferred to our center due to severe SARS-CoV-2 infection and developed a SE during hospital stay. He presented sensory level impairment during hospitalization, but an initial Head CT scan showed no alterations. A new CT scan performed six days later evidentiated a bilateral SE. The patient had a cardiorespiratory arrest during the night of the same day, resulting in death. Covid-19 as a direct cause of subdural effusion (positive Covid-19 PCR in subdural fluid) has never before been reported in the literature, and, unfortunately, it was not possible to rule out or confirm this phenomenon in our case due to the rapid evolution of the clinical picture. However, our case clearly differs from the literature as the patient did not show any signs of sinus disease or intracranial hypotension, and the possible causes of the effusion boil down to spontaneity and the direct action of Covid-19 in the CNS and subdural space.
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- 2023
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5. De sanctis-cacchione syndrome with subdural effusion: A rare case from india with review of literature.
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Kapat, Aritra, Roy, Gourab, Bhattacharjee, Angana, Mandal, Asok, Bala, Ashok, and Podder, Indrashis
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HYPOGONADISM , *EVOKED potentials (Electrophysiology) , *HYPOTHYROIDISM , *CRANIOFACIAL abnormalities , *DEMYELINATION , *SENSORINEURAL hearing loss , *MICROCEPHALY , *MAGNETIC resonance imaging , *MALNUTRITION , *AUDIOMETRY , *XERODERMA pigmentosum , *SQUAMOUS cell carcinoma , *ATAXIA , *RARE diseases , *SYMPTOMS - Abstract
De Sanctis-Cacchione syndrome (DCS) formerly known as xerodermic idiocy is characterised by cutaneous photosensitivity, microcephaly, mental retardation, short stature, hypogonadism, spasticity, peripheral neuropathy and sensorineural deafness. Here in, we present the case of a four and half years old male child with features of severe acute malnutrition (SAM) with a typical bird like facies and sunken eyes who had history of photosensitive pruritic pigmentary skin lesions on sun exposed areas from a very early age of six months. Gross developmental delay, ataxia, microcephaly, short stature, hypogonadism and cachectic wasting were identified on examination and hypertransaminasemia and hypothyroidism were recorded from biochemical profile. Subsequent visual evoked response and brainstem evoked response audiometry revealed anterior visual pathway dysfunction and bilateral profound sensorineural hearing loss. Magnetic resonance imaging of brain yielded subdural effusion with mass effect in addition to cerebro-cerebral atrophy and demyelination. Skin biopsy further detected dysplastic changes and early signs of squamous cell carcinoma (SCC). Although few cases are reported sporadically throughout the world, to our best of knowledge till date only 11 such cases have been reported completely in Indian medical literature which makes our case report the 12th one with distinctive novel association of subdural effusion. [ABSTRACT FROM AUTHOR]
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- 2023
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6. De sanctis-cacchione syndrome with subdural effusion: A rare case from india with review of literature
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Aritra Kapat, Gourab Roy, Angana Bhattacharjee, Asok K Mandal, Ashok K Bala, and Indrashis Podder
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de sanctis-cacchione ,hypogonadism ,squamous cell carcinoma ,subdural effusion ,xeroderma pigmentosum ,Dermatology ,RL1-803 - Abstract
De Sanctis-Cacchione syndrome (DCS) formerly known as xerodermic idiocy is characterised by cutaneous photosensitivity, microcephaly, mental retardation, short stature, hypogonadism, spasticity, peripheral neuropathy and sensorineural deafness. Here in, we present the case of a four and half years old male child with features of severe acute malnutrition (SAM) with a typical bird like facies and sunken eyes who had history of photosensitive pruritic pigmentary skin lesions on sun exposed areas from a very early age of six months. Gross developmental delay, ataxia, microcephaly, short stature, hypogonadism and cachectic wasting were identified on examination and hypertransaminasemia and hypothyroidism were recorded from biochemical profile. Subsequent visual evoked response and brainstem evoked response audiometry revealed anterior visual pathway dysfunction and bilateral profound sensorineural hearing loss. Magnetic resonance imaging of brain yielded subdural effusion with mass effect in addition to cerebro-cerebral atrophy and demyelination. Skin biopsy further detected dysplastic changes and early signs of squamous cell carcinoma (SCC). Although few cases are reported sporadically throughout the world, to our best of knowledge till date only 11 such cases have been reported completely in Indian medical literature which makes our case report the 12th one with distinctive novel association of subdural effusion.
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- 2023
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7. Effectiveness and Safety of Pressure Dressings on Reducing Subdural Effusion After Decompressive Craniectomy
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Huang W, Zhou B, Li Y, Shao Y, Peng B, Jiang X, and Xiang T
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decompressive craniectomy ,complication ,pressure dressing ,subdural effusion ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Wanyong Huang,* Bo Zhou,* Yingwei Li,* Yuansheng Shao, Bo Peng, Xianchun Jiang, Tao Xiang Department of Neurosurgery, People’s Hospital of Guanghan City, Guanghan City, Sichuan Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wanyong HuangDepartment of Neurosurgery, People’s Hospital of Guanghan City, 75 Hankou Road, Luocheng Town, Guanghan City, Sichuan Province, People’s Republic of ChinaEmail huangwy459088699@163.comObjective: Decompressive craniectomy as a treatment is often used in the rescue treatment of critically ill patients in neurosurgery; however, there are many complications after this operation. Subdural effusion is a common complication after decompressive craniectomy. Once it occurs, it can cause further problems for the patient. Therefore, the purpose of this study was to explore the safety and effectiveness of pressure dressings for subdural effusion after decompressive craniectomy.Methods: Patients who underwent decompressive craniectomy in our hospital from January 2016 to January 2021 were included in this study, and all patients were followed up for 6 months or more. After the operation, the patients were divided into two groups according to whether they received a pressure dressing or a traditional dressing. Subdural effusion, cerebrospinal fluid leakage, hydrocephalus and other complications were compared between the two groups, and the differences in hospital duration, cost and prognosis between the two groups were analyzed.Results: A total of 123 patients were included in this study. Among them, 62 patients chose pressure dressings, and 61 patients chose traditional dressings. The incidence of subdural effusion in the pressure dressing group was significantly lower than that in the traditional dressing group (P< 0.05). There was no difference between the two groups in cerebrospinal fluid leakage and hydrocephalus (P > 0.05). In addition, the length of hospital stay and the total cost in the pressure dressing group were significantly lower (P< 0.05).Conclusion: Pressure dressing can effectively reduce the occurrence of subdural effusion after decompressive craniectomy, and it does not increase the occurrence of other cerebrospinal fluid-related complications.Keywords: decompressive craniectomy, complication, pressure dressing, subdural effusion
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- 2021
8. Immediate improvement in GCS following needle aspiration of bilateral traumatic subdural effusion in a child in emergency room
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Ahtesham Khizar and Pradhumna Kumar Yadav
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GCS ,needle aspiration ,subdural effusion ,trauma ,Medicine ,Medicine (General) ,R5-920 - Abstract
Abstract A minor head injury can cause traumatic subdural effusion in a child. They often present to pediatric emergencies initially, and there is a delayed referral to neurosurgery. In the emergency room, they should undergo subdural effusion needle aspiration, which can result in an immediate improvement in GCS.
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- 2022
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9. Bilateral subdural effusions and brainstem sagging following labor epidural—Case report and literature review
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Joanna M Krawczyk and Jake Hartford-Beynon
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dural puncture ,epidural analgesia ,post-dural puncture headache ,subdural effusion ,subdural hygroma ,Anesthesiology ,RD78.3-87.3 ,Gynecology and obstetrics ,RG1-991 - Abstract
Epidural analgesia is a technique commonly used in labor. Intracranial subdural hygromas are a rare complication of neuraxial techniques and have only been reported in a handful of patients. We report a case of a female with postpartum headache, presenting 5 days after delivery where epidural analgesia was used, who was found to have bilateral subdural effusions and brainstem sagging. Our literature review summarizes pathophysiology, imaging, and approach to treatment, as well as guidance on long-term outcomes and follow-up needed in this patient population.
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- 2021
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10. Endoscopic-assisted surgery for skull defects with subdural effusion
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Jian-Yun Zhou, Xin Zhang, Hai-Bin Gao, Ze Cao, and Wei Sun
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skull defect ,subdural effusion ,endoscopic. ,Medicine - Published
- 2020
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11. Analysis of risk factors for transformation of traumatic subdural effusion into chronic subdural hematoma
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Pan YI, Cun-zu WANG, Pin CHEN, Dong-dong WANG, Hui WANG, Shi-wei HE, and Wei ZENG
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brain injuries, traumatic ,subdural effusion ,hematoma, subdural ,risk factors ,logistic models ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective To analyze the risk factors of traumatic subdural effusion (TSE) transforming into chronic subdural hematoma (CSDH). Methods A totalof75 patients with TSE after traumatic brain injury (TBI) were included from December 2017 to July 2019. CT or MRI reexamination during treatment and follow⁃up were performed to observe whether CSDH was transformed and relevant influencing factors were analyzed. Univariate and multivariate Logistic regression analyses were performed to screen the risk factors for the transformation of TSE into CSDH. Results Logistic regression analysis showed that the higher effusion density (OR =6.021, 95%CI: 1.047-34.631; P =0.044), subdural effusion increases for a long time (OR = 1.253, 95%CI: 1.002-1.568; P = 0.048), the thicker effusion (OR = 2.080, 95%CI: 1.267-3.414; P =0.004) and brain atrophy (OR =35.392, 95%CI: 1.397-896.474; P =0.031) were risk factors for the transformation of TSE into CSDH. Conclusions The subdural effusion increases for a long time, higher effusion density, thicker effusion and brain atrophy are the risk factors associated with the transformation of TSE into CSDH. DOI:10.3969/j.issn.1672⁃6731.2020.07.008
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- 2020
12. Analysis of Scores of SCL-90 of Patients with Traumatic Subdural Effusion
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XU Ya-jun, WANG Qiang, SU Li,et al.
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forensic psychiatry ,subdural effusion ,craniocerebral trauma ,symptom check list-90 (scl-90) ,mental state ,Medicine - Abstract
Objective To investigate the factors affecting changes of Symptom Check List-90 (SCL-90) of patients with traumatic subdural effusion. Methods One hundred and forty-two cases of patients with traumatic subdural effusion from the Center of Forensic Identification, Wannan Medical College collected from 2007—2018 were tested with SCL-90. The differences between SCL-90 results and the national norm and the influences of gender, age, education level, the number of effusion sites and location on SCL-90 results were analyzed. Results The differences between the scores of somatization, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia and psychosis factors and total mean scores in SCL-90 of traumatic subdural effusion and that of the national norm had statistical significance (P
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- 2020
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13. Efficacy of different treatments for progressive subdural effusion after decompressive craniectomy for craniocerebral injury
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FAN Yingjun, WANG Qiongfen, YANG Zhongxin, LIU Haibo, ZHANG Jie, and WANG Enren
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craniocerebral trauma ,decompressive craniectomy ,subdural effusion ,drainage of lumbar cisterna ,clinical efficacy ,Medicine (General) ,R5-920 - Abstract
Objective To investigate the clinical efficacy and complications of different treatments for progressive subdural effusion (SDE) after decompressive craniectomy for craniocerebral injury. Methods We retrospectively analyzed the clinical and follow-up data of 65 patients with progressive SDE after decompressive craniectomy for craniocerebral injury, who were admitted in our hospital between February, 2013 and March, 2019. Thirty-four of the patients (21 male and 13 female patients) received borehole drainage or local puncture drainage combined with compression dressing with elastic bandage and continuous drainage of the lumbar cistern (observation group), and 31 (17 male and 14 female patients) received borehole drainage or local puncture drainage with compression dressing with elastic bandage (control group). The occurrence time of SDE, retention time of head drainage tube, hospital stay after treatment, one-off cure rate and the incidence of complications were analyzed in the 2 groups, and the Glasgow Outcome Scale (GOS) scores of patients before and at 3 and 6 months after the treatment were compared. Results The retention time of head drainage tube, the time from local drainage to SDE disappearance and hospital stay after treatment were significantly shorter (P < 0.05), and the one-off cure rate (P < 0.05) was significantly higher in the observation group than in the control group. The overall incidence of complications was 23.53% in the observation group and 48.39% in the control group, showing a significant difference between the 2 groups (P < 0.05). There was no significant difference in GOS scores between the 2 groups before the treatments (P>0.05), but at 3 and 6 months after the treatments, GOS scores was significantly higher in the observation group than in the control group (P < 0.05). Conclusion For patients with progressive SDE after decompressive craniectomy for craniocerebral injury, combined treatment with borehole drainage or local puncture drainage, compression dressing with elastic bandage and continuous drainage of the lumbar cistern can improve the one-off cure rate of SDE, reduce the incidence of the overall complications, shorten the duration of hospital stays and improve the prognosis of the patients.
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- 2020
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14. How to distinguish confusing clinical entities; acute subdural hematoma and enhanced subdural effusions after an endovascular procedure?
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Junki Sogano, Katsuhiro Mizutani, Shunsuke Shibao, and Hideyuki Tomita
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Subdural effusion ,Acute subdural hematoma ,Dural sinus ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Enhancing subdural effusions (SDEs) after angiography may imitate acute subdural hematoma (ASDH), and differentiation between these two clinical entities is sometimes confusing. We present a case of enhancing SDE mimicking ASDH after an endovascular procedure for head trauma. Although dual-energy CT (DECT) might be an ideal tool for this situation, it is not available in every hospital. In addition, the standard protocol to distinguish these two clinical entities has not been well established. We demonstrate that the comparison of CT attenuation values of the dural sinus and subdural collection is key to differentiation, and comprehensive radiological and clinical evaluation based especially on the kinetics of contrast agents should be carefully considered.
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- 2021
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15. The role and mechanism of immunotherapy in pediatric subdural Effusion:Case reports and literature review.
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Zhang X, Huang LS, Chao HM, Zhao CY, Sheng GX, and Gao F
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Background: Due to its obscure etiology and diverse clinical manifestations, the treatment of subdural effusion, presents challenges, and the condition's progression to chronic subdural hematoma(cSDH) often necessitates surgical intervention.This study reports on two pediatric patients who developed progressive subdural effusion following minor head injuries. Both cases were notable for the detection of low levels of human herpesvirus in the cerebrospinal fluid, despite other tests returning negative. Immunotherapy led to a dramatic absorption of their subdural effusions, resulting in very positive clinical outcome., Case Description: Case 1: This involved a 4-year and 1-month-old boy who was diagnosed with acute cerebellitis due to an unstable gait following a fall. After being discharged, he sustained another minor head injury. A follow-up Magnetic Resonance Imaging (MRI) revealed an increasing and shifting subdural effusion, which was rapidly absorbed following treatment with high doses of methylprednisolone. Case 2: A 6-year and 3-month-old boy presented with headaches following a minor fall. He improved after treatment with intravenous immunoglobulin and low-dose methylprednisolone. The subdural effusion was completely absorbed, and his health remained stable four months after discharge., Conclusion: Our findings suggest that immune inflammation may play a critical role in the development of subdural effusion. The successful treatment outcomes emphasize the potential of immunotherapy as a non-invasive option for managing subdural effusion, particularly in children with unexplained conditions following minor trauma., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)
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- 2024
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16. Study to Evaluate Safety & Effectiveness of Spinal Sealant
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Medtronic - MITG
- Published
- 2017
17. Immediate improvement in GCS following needle aspiration of bilateral traumatic subdural effusion in a child in emergency room.
- Author
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Khizar, Ahtesham and Kumar Yadav, Pradhumna
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HOSPITAL emergency services , *EXUDATES & transudates , *PEDIATRIC emergencies , *HEAD injuries - Abstract
A minor head injury can cause traumatic subdural effusion in a child. They often present to pediatric emergencies initially, and there is a delayed referral to neurosurgery. In the emergency room, they should undergo subdural effusion needle aspiration, which can result in an immediate improvement in GCS. [ABSTRACT FROM AUTHOR]
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- 2022
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18. A Randomised Controlled Trial to Evaluate Long-term Drainage for Patients Undergoing Decompressive Craniectomy With the Complication of Subdural Diffusion.
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DECOMPRESSIVE craniectomy ,RANDOMIZED controlled trials ,DRAINAGE - Abstract
This document provides information about a clinical trial conducted by RenJi Hospital in China. The trial aims to evaluate the effectiveness of long-term drainage versus short-term drainage in patients who have undergone unilateral decompressive craniotomy surgery for traumatic brain injury. The study will involve 160 participants and is expected to be completed by December 2027. The eligibility criteria for participants are outlined, and contact information for the primary and backup contacts is provided. The trial is registered under the NCT number NCT06391203. [Extracted from the article]
- Published
- 2024
19. Management of subdural effusion and hydrocephalus following decompressive craniectomy for posttraumatic cerebral infarction in a patient with traumatic brain injury: a case report
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Ruhong Wu, Yun Ye, Tao Ma, Geng Jia, and Huaping Qin
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Decompressive craniectomy ,Hydrocephalus ,Posttraumatic cerebral infarction ,Subdural effusion ,Subdural effusion with hydrocephalus ,Surgery ,RD1-811 - Abstract
Abstract Background Subdural effusion with hydrocephalus (SDEH) is a rare complication of traumatic brain injury, especially following decompressive craniectomy (DC) for posttraumatic cerebral infarction. The diagnosis and treatment are still difficult and controversial for neurosurgeons. Case presentation A 45-year-old man developed traumatic cerebral infarction after traumatic brain injury and underwent DC because of the mass effect of cerebral infarction. Unfortunately, the complications of traumatic subdural effusion (SDE) and hydrocephalus occurred in succession following DC. Burr-hole drainage and subdural peritoneal shunt were performed in sequence because of the mass effect of SDE, which only temporarily improved the symptoms of the patient. Cranioplasty and ventriculoperitoneal shunt were performed ultimately, after which SDE disappeared completely. However, the patient remains severely disabled, with a Glasgow Outcome Scale of 3. Conclusions It is important for neurosurgeons to consider the presence of accompanying hydrocephalus when treating patients with SDE. Once the diagnosis of SDEH is established and the SDE has no mass effect, timely ventriculoperitoneal shunt may be needed to avoid multiple surgical procedures, which is a safe and effective surgical method to treat SDEH.
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- 2019
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20. Typical subdural contrast effusion secondary to endovascular treatment of a pediatric pial arteriovenous fistula.
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Yan, Wen-Tao, Li, Xiu-Zhen, Yan, Chang-Xiang, and Liu, Jia-Chun
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ENDOVASCULAR surgery , *ARTERIOVENOUS fistula , *DIGITAL subtraction angiography , *PEDIATRIC therapy , *EXUDATES & transudates , *CRANIAL sinuses - Abstract
Subdural contrast effusion secondary to endovascular treatment is exceptionally rare and might be mistaken as subdural hematoma because of similar hyperattenuation on computer tomography. The authors present the case of a 13-month-old girl with a history of increased head circumference and developmental retardation. Cerebral digital subtraction angiography showed a high-flow pial arteriovenous fistula fed by multiple arteries on the right cerebellar surface, with occlusion of the right sigmoid sinus and severe stenosis of the left sigmoid sinus. Staged endovascular treatments were performed to eliminate the fistula. Follow-up head computer tomography scans performed 3 h after both procedures demonstrated typical high-density subdural effusion with computer tomography attenuation value similar to hemorrhage. These effusions did not aggravate the condition and disappeared spontaneously 32 h after the first treatment and 29 h after the second, respectively. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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21. A Rare Complication of Central Venous Catheterization Interventions: Subdural Effusion.
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Misirlioglu, Merve, Horoz, Ozden Ozgur, Yildizdas, Dincer, Ekinci, Faruk, Yontem, Ahmet, and Pehlivan, Umur Anil
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SPINAL canal , *PERIPHERAL central venous catheterization , *MENINGITIS , *ADVERSE health care events , *CHILDREN - Abstract
Central venous catheterization interventions are used in various clinics for diagnostic and treatment purposes. Establishing vascular access is a difficult and critical step, especially in critically ill pediatric patients. Complications include ventricular arrhythmia, air embolism, carotid artery puncture, cardiac tamponade, pneumothorax, hemothorax, artery-vein laceration, thoracic duct injury, and catheter malposition can be observed in patients after central venous catheterization interventions. In this case report, a pediatric case was discussed, in which a central venous catheter was inserted without the usage of imaging methods and without confirming the location and was used, even though no blood return was obtained. It was aimed to draw attention to subdural effusions and spinal canal interventions, which is a rare complication of central venous catheterization interventions. [ABSTRACT FROM AUTHOR]
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- 2022
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22. Bilateral subdural effusions and brainstem sagging following labor epidural—Case report and literature review.
- Author
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Krawczyk, Joanna and Hartford-Beynon, Jake
- Subjects
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EXUDATES & transudates , *LITERATURE reviews , *BRAIN stem , *EPIDURAL analgesia , *PATHOLOGICAL physiology - Abstract
Epidural analgesia is a technique commonly used in labor. Intracranial subdural hygromas are a rare complication of neuraxial techniques and have only been reported in a handful of patients. We report a case of a female with postpartum headache, presenting 5 days after delivery where epidural analgesia was used, who was found to have bilateral subdural effusions and brainstem sagging. Our literature review summarizes pathophysiology, imaging, and approach to treatment, as well as guidance on long-term outcomes and follow-up needed in this patient population. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
23. Endoscopic-assisted surgery for skull defects with subdural effusion.
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Jian-Yun Zhou, Xin Zhang, Hai-Bin Gao, Ze Cao, and Wei Sun
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SKULL surgery , *EXUDATES & transudates , *CEREBROSPINAL fluid , *OPERATIVE surgery , *DECOMPRESSIVE craniectomy , *EXTERIOR walls , *CHEMICAL peel - Abstract
Introduction: Subdural effusion is a common complication that occurs after decompressive craniectomy. According to the endoscopy results, the formation mechanism of subdural effusion after decompressive craniectomy was discussed. Aim: The morphological structure of subdural effusion in skull defects was observed with endoscopy, and endoscopic- assisted surgery was performed for subdural effusion. Material and methods: From January 2018 to March 2020, 19 cases of skull repair and treatment of subdural effusion were performed. The external wall of the capsule was kept intact during the operation, subdural effusion and surgical procedure of the subdural effusion under an endoscope could be observed, and the results of endoscopic observation were described and recorded. A hemostasis gauze was placed between the two layers of the subdural effusion cavity. Another 13 cases of skull defects with subdural effusion treated without endoscopy during the same time period were enrolled in the study as the control group. The postoperative disappearance of effusion and the incidence of postoperative complications were compared between the two groups. Results: Analysis with an endoscope revealed that all cases of subdural effusion in skull defects presented capsules. The main structures included the outer wall, boundary, inner wall, and fistula. The outer wall was made up of new tissue that had formed after removing the bone flap under the skin flap by artificial peeling under the condition of keeping the whole cavity. The inner wall consisted of thickened arachnoid, dura, and artificial dura. It presented with neovascularization networks, which showed a tendency to form new membrane structures through mutual adhesion and fusion. The inner and outer wall of the skull had fused to form the boundary of the cavity. Cerebrospinal fluid fistulas were detected in 31.6% of the internal walls. Subdural effusion was effectively treated in both the experimental group and the control group. Compared with the control group, complications in the experimental group were significantly reduced. Conclusions: The effusion cavity can be divided into three types based on its structural characteristics: fistula type, membrane type, and closed type. In this study, the formation mechanism of skull defects combined with subdural effusion was explored. This represents a new method for treating subdural effusion in which hemostasis gauze is placed between the two layers of the effusion cavity and cerebrospinal fluid fistula under an endoscope, which can effectively reduce the incidence of postoperative complications. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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24. Subdural effusion associated with COVID-19 encephalopathy: A case report.
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Xue ZY, Xiao ZL, Cheng M, Xiang T, Wu XL, Ai QL, Wu YL, and Yang T
- Abstract
Background: The precise mechanism by which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacts the central nervous system remains unclear, with manifestations spanning from mild symptoms ( e.g., olfactory and gustatory deficits, hallucinations, and headache) to severe complications ( e.g., stroke, seizures, encephalitis, and neurally demyelinating lesions). The occurrence of single-pass subdural effusion, as described below, is extremely rare., Case Summary: A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms. Through comprehensive imaging and diagnostic assessments, he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal, temporal, and parietal regions. In addition, an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process; consequently, an idiopathic subdural effusion developed. Remarkably, the subdural effusion underwent absorption within 6 d, with no recurrence observed during the 3-month follow-up., Conclusion: Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2024
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- View/download PDF
25. Clinical analysis of hyperbaric oxygen combined with subdural drilling and drainage in the management of subdural effusion type IV with intracranial infection in infant patients.
- Author
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Chen L, Yue Y, Luo P, Qu Y, Fang J, Xin C, Lv L, Luan J, Cheng Z, Yang Z, and Sun Y
- Abstract
Background: To explore the therapeutic effect of hyperbaric oxygen combined with subdural drilling and drainage (SDD) on subdural effusion type IV with intracranial infection in infant patients., Methods: This retrospective controlled study included 328 infant patients with subdural effusion type 4 with intracranial infection between January 2005 and January 2023. 178 patients were treated by hyperbaric oxygen combined with SDD (group A). 142 cases were treated with SDD (group B). 97 infants were only received hyperbaric oxygen (group C). Clinical outcomes, the control time of intracranial infection, complications, and the degree of brain re-expansion after 6 months of treatment were compared among the three groups. According to the comprehensive evaluation of treatment effectiveness and imaging results, it is divided into four levels: cured, significantly effective, improved, and ineffective., Results: No patient died during follow-up. The three groups were similar regarding age, sex, the general information, and clinical symptoms ( p > 0.05). All intracranial infections in the children were effectively controlled. There was no difference in infection control time between group A and group B, and there was no statistical significance. However, the control time of intracranial infection between the two groups was different from that of group C, which was statistically significant. Compared with group B and group C, the degree of brain re-expansion in group A has obvious advantages and significant differences. The effective rates of the three groups were 83.7%, 58.5%, and 56.7%, respectively. There were 28 cases of subcutaneous hydrops in group A and 22 cases of subcutaneous hydrops in group B after operation, and no other serious complications., Conclusion: The SDD is safe and effective for infant patients with intracranial infections through fluid replacement and intrathecal antibacterial. Hyperbaric oxygen is effective as an adjuvant therapy to promote brain re-expansion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chen, Yue, Luo, Qu, Fang, Xin, Lv, Luan, Cheng, Yang and Sun.)
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- 2024
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26. Analysis of risk factors for transformation of traumatic subdural effusion into chronic subdural hematoma.
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YI Pan, WANG Cun-zu, CHEN Pin, WANG Dong-dong, WANG Hui, HE Shi-wei, and ZENG Wei
- Subjects
CHRONIC disease risk factors ,BRAIN injuries ,COMPUTED tomography ,CONFIDENCE intervals ,MAGNETIC resonance imaging ,MENINGITIS ,RISK assessment ,STATISTICS ,SUBDURAL hematoma ,LOGISTIC regression analysis ,DESCRIPTIVE statistics ,ODDS ratio ,DISEASE complications - Abstract
Objective To analyze the risk factors of traumatic subdural effusion (TSE) transforming into chronic subdural hematoma (CSDH). Methods A total of 75 patients with TSE after traumatic brain injury (TBI) were included from December 2017 to July 2019. CT or MRI reexamination during treatment and follow-up were performed to observe whether CSDH was transformed and relevant influencing factors were analyzed. Univariate and multivariate Logistic regression analyses were performed to screen the risk factors for the transformation of TSE into CSDH. Results Logistic regression analysis showed that the higher effusion density (OR = 6.021, 95% CI: 1.047-34.631; P = 0.044), subdural effusion increases for a long time (OR = 1.253, 95% CI: 1.002-1.568; P = 0.048), the thicker effusion (OR = 2.080, 95% CI: 1.267-3.414; P = 0.004) and brain atrophy (OR = 35.392, 95% CI: 1.397-896.474; P = 0.031) were risk factors for the transformation of TSE into CSDH. Conclusions The subdural effusion increases for a long time, higher effusion density, thicker effusion and brain atrophy are the risk factors associated with the transformation of TSE into CSDH. [ABSTRACT FROM AUTHOR]
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- 2020
- Full Text
- View/download PDF
27. Symptomatic Unilateral Subdural Effusion as the First Presentation of Suprasellar Arachnoid Cyst
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Omidvar Rezaei, Karim Moradian-Kokhdan, Saeed Razmeh, Kaveh Ebrahimzadeh, Guive Sharifi, and Mohammad Samadian
- Subjects
Subdural effusion ,Suprasellar arachnoid cyst ,Surgery ,RD1-811 ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Background and Importance: Arachnoid cysts are benign nontumoral lesions that are usually found incidentally in brain imaging. Suprasellar Arachnoid Cysts (SSACs) are rare. They can cause hydrocephalus and increased intracranial pressure, lower cranial nerve impairment and endocrine disorder. Sometimes arachnoid cysts become complicated by subdural hematoma/hygroma. Case Presentation: We describe a patient with a suprasellar arachnoid cyst that was complicated with symptomatic subdural effusion and increased intracranial pressure after minor trauma. Conclusion: Although these cysts are rarely complicated with subdural hematoma/hygroma, and intracystic hemorrhage, the probability of subsequent subdural hygroma and increased intracranial pressure should not be underestimated.
- Published
- 2017
28. Surgical Treatment of Bilateral Chronic Subdural Hematoma
- Author
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Yan Zhuang, Ming Jiang, Jiahao Zhou, Jun Liu, Zhen Fang, and Zejun Chen
- Subjects
Article Subject ,General Computer Science ,Recurrence ,Hematoma, Subdural, Chronic ,General Mathematics ,General Neuroscience ,Humans ,General Medicine ,Subdural Effusion - Abstract
Background. Chronic subdural hematoma (CSDH) is one of the common clinical intracranial hemorrhagic disorders, accounting for 16%–20% of bilateral CSDH. At present, the surgical treatment of bilateral CSDH mainly includes drilling drainage and neuroendoscopic assistance. The main objective of this paper was to compare the effects of two surgical methods on CSDH. Methods. 153 patients who were diagnosed with CSDH were included in this study. 79 patients were treated with bilateral drilling drainage, and the other 74 patients were treated with neuroendoscope-assisted drainage. The clinical data of the two groups were compared, and the surgical indexes, neurological function, cure rate, and recurrence rate of the two groups were compared. The operation indexes of patients include operation time, postoperative hematoma volume, hospital stay, extubation time, misplacement of drainage tube, recurrence, and hematoma clearance rate. Results. All patients underwent CT examination one day after operation. The CT imaging detection of the two groups was generally good. The cranial CT was reexamined before discharge. The bilateral hematoma disappeared in 114 patients, the unilateral hematoma disappeared in 29 patients, a small amount of compensatory crescent very low-density shadow subdural effusion was observed on the other side, and a small amount of compensatory crescent very low-density shadow subdural effusion was observed on both sides in 10 patients. There was no space occupying effect and intracranial gas disappeared. Compared with neuroendoscopic assisted drainage, the operation time of drilling drainage patients was significantly shorter. The extubation time, drainage tube dislocation, recurrence rate, postoperative hematoma volume, and hematoma clearance rate of patients receiving neuroendoscopic assisted drainage were significantly better than those receiving drilling drainage. The Markwalder score and hospital stay between the two groups were not significant. Conclusions. Drilling drainage and neuroendoscopic assisted surgery have good therapeutic effects on bilateral CSDH. The operation time of drilling drainage is shorter. Neuroendoscopic assisted surgery has more advantages in extubation time, misplacement of drainage tube, recurrence, postoperative hematoma volume, and hematoma clearance rate.
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- 2022
29. Effectiveness and Safety of Pressure Dressings on Reducing Subdural Effusion After Decompressive Craniectomy
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Bo Zhou, Tao Xiang, Xianchun Jiang, Yingwei Li, Wanyong Huang, Yuansheng Shao, and Bo Peng
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Cerebrospinal Fluid Leakage ,medicine.medical_specialty ,decompressive craniectomy ,business.industry ,Critically ill ,medicine.medical_treatment ,complication ,medicine.disease ,Rescue treatment ,pressure dressing ,Surgery ,Hydrocephalus ,subdural effusion ,medicine ,Decompressive craniectomy ,Neurosurgery ,Complication ,business ,Subdural effusion ,Original Research - Abstract
Objective Decompressive craniectomy as a treatment is often used in the rescue treatment of critically ill patients in neurosurgery; however, there are many complications after this operation. Subdural effusion is a common complication after decompressive craniectomy. Once it occurs, it can cause further problems for the patient. Therefore, the purpose of this study was to explore the safety and effectiveness of pressure dressings for subdural effusion after decompressive craniectomy. Methods Patients who underwent decompressive craniectomy in our hospital from January 2016 to January 2021 were included in this study, and all patients were followed up for 6 months or more. After the operation, the patients were divided into two groups according to whether they received a pressure dressing or a traditional dressing. Subdural effusion, cerebrospinal fluid leakage, hydrocephalus and other complications were compared between the two groups, and the differences in hospital duration, cost and prognosis between the two groups were analyzed. Results A total of 123 patients were included in this study. Among them, 62 patients chose pressure dressings, and 61 patients chose traditional dressings. The incidence of subdural effusion in the pressure dressing group was significantly lower than that in the traditional dressing group (P 0.05). In addition, the length of hospital stay and the total cost in the pressure dressing group were significantly lower (P Conclusion Pressure dressing can effectively reduce the occurrence of subdural effusion after decompressive craniectomy, and it does not increase the occurrence of other cerebrospinal fluid-related complications.
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- 2021
30. Analysis on the risk factors of bacterial meningitis complicated with subdural effusion
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Zhi JIANG, Li-ming YANG, Jie ZHANG, Ze-shu NING, and Bo CHEN
- Subjects
Meningitis, bacterial ,Subdural effusion ,Risk factors ,Regression analysis ,Children ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective To investigate the risk factors of bacterial meningitis complicated with subdural effusion. Methods The clinical data of children with bacterial meningitis in our hospital were collected and analyzed retrospectively. Logistic regression analysis was used to investigate the risk factors for subdural effusion. Results A total of 128 cases were divided into control group (N = 64) and subdural effusion group (N = 64). There was no significant difference on serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) between 2 groups (P > 0.05, for all). Compared with control group, cerebrospinal fluid (CSF) WBC (Z = 3.126, P = 0.003), CSF protein (Z = 4.928, P = 0.000) and serum procalcitonin (PCT; Z = 2.823, P = 0.007) in subdural effusion group were significantly higher, while CSF glucose (t = 2.166, P = 0.033) was significantly lower. After treatment, CSF WBC (Z = 2.467, P = 0.012) in subdural effusion group was still significantly higher than that of control group, and CSF glucose (t = 4.938, P = 0.000) was still significantly lower. Logistic regression analysis showed that WBC in CSF (P = 0.027), CSF protein (P = 0.002) and serum PCT (P = 0.014) were independent risk factors for bacterial meningitis complicated with subdural effusion. Conclusions CSF examination of children with bacterial meningitis reveals significant increase of CSF WBC, CSF protein and serum PCT, suggesting concurrent subdural effusion is easily occurred. DOI: 10.3969/j.issn.1672-6731.2015.08.012
- Published
- 2015
31. Ventriculosinus shunt as a reliable option in the treatment of failed ventriculoperitoneal shunt: report of 19 cases and review of the literature
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Xinxing Li and Jihui Zheng
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,medicine.disease ,Ventriculoperitoneal Shunt ,Thrombosis ,Sagittal Sinus ,Surgery ,Hydrocephalus ,Shunt (medical) ,Treatment Outcome ,Anesthesiology and Pain Medicine ,medicine ,Humans ,business ,Subdural effusion ,Shunt valve ,Communicating hydrocephalus ,Intracranial pressure - Abstract
Background The authors of this study aim to summarize their experience with lateral ventriculosinus shunt in the treatment of hydrocephalus patients and assess its clinical value. Methods Ventriculoperitoneal shunt was performed but failed due to obstruction and infection of the shunt. Lateral ventriculosinus shunt was inserted in 19 hydrocephalus patients by a Medtronic programmable shunt valve. All 19 patients suffered from either an obstruction or infection after ventriculoperitoneal shunting, while 11 cases had a peritoneal obstruction, 8 cases had an intracranial infection, and 1 case had an intra-abdominal infection. Among the 19 cases, there were 2 cases with obstructive hydrocephalus and 17 cases with communicating hydrocephalus. Results All clinical symptoms of 9 patients disappeared completely, while for 8 patients, noticeable improvement was accomplished, and only 2 patients showed no improvement. All 19 cases were followed up for 6 to 60 months. During the follow-up period, in 17 patients the shunt remained effective, while 2 cases underwent removal of the shunt due to low preoperative intracranial pressure and no significant changes in postoperative symptoms and ventricular size. During follow-up there was no thrombosis in the sagittal sinus, and no infection, over drainage, intracranial hemorrhage, or subdural effusion occurred. Conclusions We demonstrate that lateral ventriculosinus shunt is a reliable option for failed ventriculoperitoneal shunt hydrocephalus patients. Nevertheless, the effectiveness and possible complications of this method need further confirmation by observation in a study with a larger cohort.
- Published
- 2021
32. Does Impaired Glymphatic Drainage Cause Glymphedema? A Review Tailored to Neurocritical Care and Neurosurgery
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Kern H. Guppy and Paul T. Akins
- Subjects
Decompressive Craniectomy ,medicine.medical_specialty ,Subarachnoid hemorrhage ,medicine.medical_treatment ,Neurosurgery ,Review Article ,Aquaporins ,Critical Care and Intensive Care Medicine ,Hydrocephalus (normal pressure) ,03 medical and health sciences ,Meninges ,0302 clinical medicine ,Subdural effusion ,medicine ,Humans ,In patient ,Brain injuries (traumatic) ,Intensive care medicine ,030304 developmental biology ,0303 health sciences ,Ischemic stroke ,business.industry ,Brain ,Neurointensive care ,medicine.disease ,Lymphatic system ,Hydrocephalus ,Astrocytes ,Cerebrospinal fluid circulation ,Glymphatic system ,Drainage ,Decompressive craniectomy ,Neurology (clinical) ,business ,Neurovascular coupling ,030217 neurology & neurosurgery - Abstract
Research into the glymphatic system reached an inflection point with steep trajectory in 2012 when it was formally recognized and named, but the historical roots for it are solid and deep, dating back to pioneers such as Cushing, Weed, and Dandy. We provide an overview of key discoveries of the glymphatic system, which promotes bulk flow of fluid and solutes throughout the brain parenchyma. We also discuss the lymphatic drainage of the central nervous system. Evidence is building that failure of the glymphatic system causes glymphedema in patients commonly managed by neurocritical care and neurosurgery specialists. We review research supporting this for decompressive craniectomy, subarachnoid hemorrhage, and normal-pressure hydrocephalus. We argue that it is time for a paradigm shift from the traditional model of cerebrospinal fluid circulation to a revised model that incorporates the glymphatic pathway and lymphatic clearance. These recent breakthroughs will inspire new therapeutic approaches to recognize, reverse, and restore glymphatic dysfunction and to leverage this pathway to deliver brain-wide therapeutics.
- Published
- 2021
33. Meningeal protein synthesis in chronic subdural hemorrhagies:analysis of proteins and evaluation of their clinical significance
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Majamaa, K. (Kari), Sajanti, J. (Juha), Heula, A.-L. (Anna-Leena), Majamaa, K. (Kari), Sajanti, J. (Juha), and Heula, A.-L. (Anna-Leena)
- Abstract
Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice affecting mainly elderly people. CSDH grows slowly within the dural border cell (DBC) layer, which is continuous with the dura and the arachnoid. Inflammatory mechanisms involving the dura mater have an acknowledged role in the progression of CSDH. Also, subarachnoid hemorrhage (SAH) induces an inflammatory cascade and yet, a fibroproliferative reaction, which reflects increased collagen synthesis in the arachnoid. Meninges are a site for active collagen synthesis in normal conditions. In this study, we aimed to evaluate the contribution of meningeal extracellular matrix synthesis, namely collagen and glycosaminoglycans, in slowly growing chronic subdural collections after head injury. The protein content of CSDH fluid was characterized in order to evaluate proteins putatively involved in CSDH pathogenesis. Altogether, 39 patients with CSDH or effusion were included in the study. The age of the hematoma was determined and subdural fluid and serum samples were assayed for the concentrations of procollagen propeptides (PICP, PIIINP, ICTP) by radioimmunoassays and of glycosaminoglycans by colorimetric methods. The proteome of CSDH fluid and serum of five patients was investigated with two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS). The results indicated that meningeal ECM synthesis is induced after cleavage of the DBC layer. Concentrations of procollagen propeptides in subdural fluid increased rapidly after head injury and remained high for at least three months. High, although variable, concentrations of glycosaminoglycans were also found. However, proteomic studies showed that CSDH proteins originate mainly from blood and the results implied the involvement of coagulation and fibrinolysis cascades in CSDH pathology. The increase of procollagen propeptides in subdural fluid may be regarded as a sign of sustained dural collagen synthesis after cleavage of the, Tiivistelmä Krooninen subduraalihematooma (pitkäaikainen kovakalvon alainen verenpurkauma) on tavallinen neurokirurgista hoitoa vaativa sairaus, jota esiintyy yleisimmin iäkkäillä potilailla. Krooninen subduraalihematooma syntyy kovakalvon rajasolukerroksen repeämisen seurauksena. Repeäminen aiheuttaa kovakalvolla inflammatorisen vasteen, mikä vaikuttaa taudin etenemiseen. Myös lukinkalvonalainen verenvuoto (subaraknoidaalivuoto) aiheuttaa lukinkalvolla inflammatorisen vasteen ja kollageenituotannon lisääntymisen. Aivokalvojen solut tuottavat kollageenia, mutta rajasolukerroksessa kollageenia ei ole. Tässä työssä tutkimme soluväliaineen, erityisesti kollageenien ja glykosaminoglykaanien, tuotantoa kroonisissa subduraalihematoomissa pään vamman jälkeen. Lisäksi tutkimme hematoomanesteen sisältämiä proteiineja ja arvioimme niiden osuutta taudin kehityksessä. Tutkimuksessa oli 39 potilasta. Subduraalihematooman iäksi määritettiin aika pään vammasta subduraalihematooman leikkaushoitoon. Prokollageenien propeptidien (PICP, PIIINP, ICTP) konsentraatio määritettiin radioimmunologisella menetelmällä ja glykosaminoglykaanien konsentraatio kolorimetrisillä menetelmillä. Hematoomanesteen ja seerumin proteomi karakterisoitiin viideltä potilaalta käyttäen kaksiulotteista elektroforeesia (2-DE) ja massaspektrometriaa (MS). Tutkimustulokset osoittivat, että rajasolukerroksen repeämän jälkeen kovakalvossa käynnistyy soluväliaineen tuotantoa. Prokollageenien propeptidien konsentraatio subduraalihematoomanesteessä lisääntyi nopeasti pään vamman jälkeen ja pysyi korkeana ainakin kolme kuukautta. Lisäksi glykosaminoglykaanien konsentraatio oli korkea, joskin vaihteleva. Proteomin analysointi osoitti, että subduraalihematoomanesteen proteiinit ovat suurimmalta osin peräisin verestä ja että subduraalihematooman laajenemiseen vaikuttavat koagulaatio- ja fibrinolyysimekanismit. Propeptidien lisääntymistä voidaan pitää merkkinä kovakalvon pitkäkestoisesta kollageenin tuotannosta rajasoluker
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- 2022
34. Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report
- Author
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Shi-Wei Li, Bo-Ding Wang, Hai Chen, Yi-Lei Tong, Maosong Chen, and Hongcai Wang
- Subjects
Abdominal pain ,medicine.medical_specialty ,lcsh:Surgery ,Hemorrhage ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Postoperative Complications ,Pseudocyst ,Abdomen ,Case report ,medicine ,Humans ,Cyst ,Subdural effusion ,Aged ,Cerebrospinal Fluid ,business.industry ,Cysts ,General Medicine ,lcsh:RD1-811 ,medicine.disease ,Ventriculoperitoneal shunt ,Hydrocephalus ,Surgery ,Catheter ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Drainage ,Female ,Laparoscopy ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Complication ,030217 neurology & neurosurgery ,Abdominal surgery - Abstract
Background Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. Case presentation This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. Conclusion To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).
- Published
- 2021
35. Bilateral optic nerve infiltration in tuberculous meningitis: A diagnostic dilemma
- Author
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Wan Hazabbah Wan Hitam, Ibrahim Mohtar, Sanihah Abdul Halim, and Lim Thiam-Hou
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,RC86-88.9 ,Medical emergencies. Critical care. Intensive care. First aid ,General Medicine ,Diagnostic dilemma ,Mantoux test ,medicine.disease ,urologic and male genital diseases ,Elevated erythrocyte sedimentation rate ,Tuberculous meningitis ,tuberculous meningitis ,infiltrative optic neuropathy ,tuberculoma ,medicine ,Optic nerve ,Tuberculoma ,Radiology ,business ,Subdural effusion ,Infiltration (medical) - Abstract
Rationale: Tuberculous meningitis (TBM) is severe extrapulmonary tuberculosis that can cause poor outcomes without timely treatment. We report a case of presumed TBM that presented solely ocular complaints without other neurological features. Patient’s concerns: A 71-year-old man presented with a sudden central visual defect in both eyes for 10 days. Fundoscopy showed bilateral hyperaemic swelling disc with infiltrates. Diagnosis: A diagnosis of presumptive TBM was made with Mantoux test reading 15 mm, elevated erythrocyte sedimentation rate, subdural effusion on CT scan, and high opening pressure. Intervention: Anti-tuberculous treatment. Outcomes: Bilateral vision improved and optic discs swelling resolved. Lessons: Early recognition of TBM with optic nerve infiltration is crucial for prompt treatment that may lead to a good prognosis. Neuroimaging will facilitate the diagnosis when other investigations show a borderline result.
- Published
- 2021
36. Infratentorial subdural effusion: an imaging hint of a first-seen intracerebral Corynespora cassiicola infection
- Author
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Xindi Song, Wei Dong, Jing Zhou, and Xiaoqi Xie
- Subjects
Ascomycota ,Humans ,Critical Care and Intensive Care Medicine ,Subdural Effusion - Published
- 2022
37. Meningeal protein synthesis in chronic subdural hemorrhagies:analysis of proteins and evaluation of their clinical significance
- Author
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Heula, A.-L. (Anna-Leena), Majamaa, K. (Kari), and Sajanti, J. (Juha)
- Subjects
proteomi ,extracellular matrix ,proteome ,fibrosis ,procollagen ,sidekudokset ,subduraalieffuusio ,subdural effusion ,glycosaminoglycan ,glykosaminoglykaani ,soluväliaine ,prokollageeni ,fibroosi ,connective tissue - Abstract
Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice affecting mainly elderly people. CSDH grows slowly within the dural border cell (DBC) layer, which is continuous with the dura and the arachnoid. Inflammatory mechanisms involving the dura mater have an acknowledged role in the progression of CSDH. Also, subarachnoid hemorrhage (SAH) induces an inflammatory cascade and yet, a fibroproliferative reaction, which reflects increased collagen synthesis in the arachnoid. Meninges are a site for active collagen synthesis in normal conditions. In this study, we aimed to evaluate the contribution of meningeal extracellular matrix synthesis, namely collagen and glycosaminoglycans, in slowly growing chronic subdural collections after head injury. The protein content of CSDH fluid was characterized in order to evaluate proteins putatively involved in CSDH pathogenesis. Altogether, 39 patients with CSDH or effusion were included in the study. The age of the hematoma was determined and subdural fluid and serum samples were assayed for the concentrations of procollagen propeptides (PICP, PIIINP, ICTP) by radioimmunoassays and of glycosaminoglycans by colorimetric methods. The proteome of CSDH fluid and serum of five patients was investigated with two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS). The results indicated that meningeal ECM synthesis is induced after cleavage of the DBC layer. Concentrations of procollagen propeptides in subdural fluid increased rapidly after head injury and remained high for at least three months. High, although variable, concentrations of glycosaminoglycans were also found. However, proteomic studies showed that CSDH proteins originate mainly from blood and the results implied the involvement of coagulation and fibrinolysis cascades in CSDH pathology. The increase of procollagen propeptides in subdural fluid may be regarded as a sign of sustained dural collagen synthesis after cleavage of the DBC layer. Glycosaminoglycans may participate in the reactive process. Proteins with a potential role in CSDH pathogenesis were detected in CSDH fluid, including transforming growth factor-β-induced protein TGFBI and altered components of the complement. Sustained inflammation may induce aberrant wound healing and meningeal fibrosis after cleavage of the DBC layer. Tiivistelmä Krooninen subduraalihematooma (pitkäaikainen kovakalvon alainen verenpurkauma) on tavallinen neurokirurgista hoitoa vaativa sairaus, jota esiintyy yleisimmin iäkkäillä potilailla. Krooninen subduraalihematooma syntyy kovakalvon rajasolukerroksen repeämisen seurauksena. Repeäminen aiheuttaa kovakalvolla inflammatorisen vasteen, mikä vaikuttaa taudin etenemiseen. Myös lukinkalvonalainen verenvuoto (subaraknoidaalivuoto) aiheuttaa lukinkalvolla inflammatorisen vasteen ja kollageenituotannon lisääntymisen. Aivokalvojen solut tuottavat kollageenia, mutta rajasolukerroksessa kollageenia ei ole. Tässä työssä tutkimme soluväliaineen, erityisesti kollageenien ja glykosaminoglykaanien, tuotantoa kroonisissa subduraalihematoomissa pään vamman jälkeen. Lisäksi tutkimme hematoomanesteen sisältämiä proteiineja ja arvioimme niiden osuutta taudin kehityksessä. Tutkimuksessa oli 39 potilasta. Subduraalihematooman iäksi määritettiin aika pään vammasta subduraalihematooman leikkaushoitoon. Prokollageenien propeptidien (PICP, PIIINP, ICTP) konsentraatio määritettiin radioimmunologisella menetelmällä ja glykosaminoglykaanien konsentraatio kolorimetrisillä menetelmillä. Hematoomanesteen ja seerumin proteomi karakterisoitiin viideltä potilaalta käyttäen kaksiulotteista elektroforeesia (2-DE) ja massaspektrometriaa (MS). Tutkimustulokset osoittivat, että rajasolukerroksen repeämän jälkeen kovakalvossa käynnistyy soluväliaineen tuotantoa. Prokollageenien propeptidien konsentraatio subduraalihematoomanesteessä lisääntyi nopeasti pään vamman jälkeen ja pysyi korkeana ainakin kolme kuukautta. Lisäksi glykosaminoglykaanien konsentraatio oli korkea, joskin vaihteleva. Proteomin analysointi osoitti, että subduraalihematoomanesteen proteiinit ovat suurimmalta osin peräisin verestä ja että subduraalihematooman laajenemiseen vaikuttavat koagulaatio- ja fibrinolyysimekanismit. Propeptidien lisääntymistä voidaan pitää merkkinä kovakalvon pitkäkestoisesta kollageenin tuotannosta rajasolukerroksen repeämisen jälkeen. Glykosaminoglykaanit voivat osallistua kudosvaurion jälkeiseen reaktiiviseen tapahtumasarjaan. Hematoomanesteessä havaittiin taudin patogeneesiin mahdollisesti vaikuttavia proteiineja, kuten TGFBI ja osia komplementista. Pitkittynyt inflammaatio kovakalvon rajasolukerroksen repeämisen jälkeen voi johtaa fibroottiseen reaktioon aivokalvoilla.
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- 2022
38. Delayed extensive lumbar sub-dural effusion following discectomy - Clinical imaging and case report.
- Author
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Kaliya-Perumal, Arun-Kumar, Meng-Ling Lu, Fu-Cheng Kao, and Chi-Chien Niu
- Abstract
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. [ABSTRACT FROM AUTHOR]
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- 2017
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39. Radiologic Follow-up of Ruptured Arachnoid Cysts With or Without Hemorrhage: Five Case Reports and a Review of the Literature.
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Kim GE, Park SJ, Kim YJ, Kim SK, and Jung TY
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Arachnoid cysts are usually asymptomatic and discovered incidentally. However, cysts may occasionally rupture because of minor head trauma. We describe the radiologic follow-up of 5 patients with ruptured arachnoid cysts featuring spontaneous resolution, subdural hygroma formation, and cystic and subdural hemorrhage. From January 2004 through July 2020, 5 patients (1.3%) with ruptured arachnoid cysts were evaluated out of 388 patients with arachnoid cysts encountered at our institution at that time. The 5 patients were all male, and they ranged in age from 6-17 years (median, 12 years). The median duration of radiologic follow-up was 3.5 years (range, 2.3-10.1 years). All of the ruptured arachnoid cysts were overlying the temporal lobe with Galassi type II. The median cyst diameter was 4.9 cm (range, 4.4-8.9 cm). Four patients had a history of recent minor head trauma. There were no particular neurologic symptoms in their past medical history in all patients. In the follow-up, two patients' cysts resolved spontaneously without hemorrhage. One patient's cyst resolved post-burr-hole drainage for chronic subdural hemorrhage. Another patient, whose cyst led to a hemorrhage and chronic subdural hemorrhage, recovered following a craniotomy, hematoma removal, and cyst fenestration. Another patient, presenting with hygroma, cystic hemorrhage, and chronic subdural hemorrhage, was treated with burr-hole drainage. Three patients recovered postoperatively. Arachnoid cysts rarely rupture, and surgical intervention is required for some cases associated with hemorrhage. Postoperatively, all patients had good outcomes without complications in this series., Competing Interests: The authors have no potential conflicts of interest to disclose., (Copyright © 2023 The Korean Brain Tumor Society, The Korean Society for Neuro-Oncology, and The Korean Society for Pediatric Neuro-Oncology.)
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- 2023
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40. Rectal dural metastasis masquerading as chronic subdural hematoma: illustrative case.
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Siy HFC, Pacia EMJB, Ong AO, Ong-Lingan M, and Rosales PP
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Background: Intracranial dural metastasis causing subdural hematoma formation is a rare clinical entity associated with significant morbidity and mortality. A 61-year-old female patient known to have rectal signet ring cell carcinoma presented with cranial computed tomography scan findings of bilateral subdural hematoma. She underwent evacuation of the hematoma with dural biopsy, which showed tumor emboli consistent with colorectal origin. There was an early recurrence of the subdural collection, and an emergency subdural-peritoneal shunt insertion was done; however, there was no sustained clinical improvement. This work reports the first case of rectal dural metastasis presenting as chronic subdural hematoma and discusses the clinical course and current literature., Observations: The cases described in these studies are consistent with the clinical course of our patient; that is, evacuation of the subdural hematoma provided temporary clinical improvement and re-accumulation occurred within 3 days., Lessons: The authors recommend maintaining a high index of suspicion in this select group of patients, including prompt discussion about treatment plans with the patient's family.
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- 2023
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41. Herpes Simplex Encephalitis: An Uncommon Presentation
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Nidhi Kaeley, Sunil Bansal, Rohan Bhatia, and Sohaib Ahmad
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psychosis ,polymerase chain reaction ,subdural effusion ,viral encephalitis ,Medicine - Abstract
Herpes Simplex Virus (HSV) encephalitis is an uncommon illness, with about 2 cases per 250,000 per year. Most are caused by HSV-1, with 10% having HSV-2 as the aetiologic factor. We present a case of Herpes simplex type1encephalitis in a 70 year old male with an uncommon presentation. The patient was a known case of endogenous depression with no medical records and on no treatment for the same, reported with acute changes in mental state for the past five days. He was talking irrelevantly, had hallucinations and was unduly aggressive and violent. He was subjected to a thorough clinical and diagnostic work-up which included cerebrospinal fluid analysis, CT head and MRI brain. MRI brain was suggestive of mild subdural effusion which hinted towards infectious cause of encephalitis. The cerebrospinal fluid viral serology panel detected herpes simplex type 1 virus (HSV1) that was later confirmed by CSF Polymerase Chain Reaction (PCR) technique. Hence, acyclovir was initiated by intravenous route at a dosage of 10mg/kg body weight and continued for two weeks. This case holds significance in view of the fact that organic causes must be excluded in suspected cases of psychiatric illness especially in the absence of fever. Also, CSF-PCR testing plays a pivotal role in diagnosing herpes simplex encephalitis.
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- 2016
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42. Endoscopic-assisted surgery for skull defects with subdural effusion
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Ze Cao, Hai-Bin Gao, Xin Zhang, Jian-Yun Zhou, and Wei Sun
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medicine.medical_specialty ,endoscopic ,Endoscope ,Urology ,Fistula ,medicine.medical_treatment ,Adhesion (medicine) ,skull defect ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Subdural effusion ,Original Paper ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Obstetrics and Gynecology ,030208 emergency & critical care medicine ,medicine.disease ,Surgery ,Endoscopy ,subdural effusion ,Skull ,medicine.anatomical_structure ,Effusion ,Medicine ,Decompressive craniectomy ,business ,030217 neurology & neurosurgery - Abstract
Introduction Subdural effusion is a common complication that occurs after decompressive craniectomy. According to the endoscopy results, the formation mechanism of subdural effusion after decompressive craniectomy was discussed. Aim The morphological structure of subdural effusion in skull defects was observed with endoscopy, and endoscopic-assisted surgery was performed for subdural effusion. Material and methods From January 2018 to March 2020, 19 cases of skull repair and treatment of subdural effusion were performed. The external wall of the capsule was kept intact during the operation, subdural effusion and surgical procedure of the subdural effusion under an endoscope could be observed, and the results of endoscopic observation were described and recorded. A hemostasis gauze was placed between the two layers of the subdural effusion cavity. Another 13 cases of skull defects with subdural effusion treated without endoscopy during the same time period were enrolled in the study as the control group. The postoperative disappearance of effusion and the incidence of postoperative complications were compared between the two groups. Results Analysis with an endoscope revealed that all cases of subdural effusion in skull defects presented capsules. The main structures included the outer wall, boundary, inner wall, and fistula. The outer wall was made up of new tissue that had formed after removing the bone flap under the skin flap by artificial peeling under the condition of keeping the whole cavity. The inner wall consisted of thickened arachnoid, dura, and artificial dura. It presented with neovascularization networks, which showed a tendency to form new membrane structures through mutual adhesion and fusion. The inner and outer wall of the skull had fused to form the boundary of the cavity. Cerebrospinal fluid fistulas were detected in 31.6% of the internal walls. Subdural effusion was effectively treated in both the experimental group and the control group. Compared with the control group, complications in the experimental group were significantly reduced. Conclusions The effusion cavity can be divided into three types based on its structural characteristics: fistula type, membrane type, and closed type. In this study, the formation mechanism of skull defects combined with subdural effusion was explored. This represents a new method for treating subdural effusion in which hemostasis gauze is placed between the two layers of the effusion cavity and cerebrospinal fluid fistula under an endoscope, which can effectively reduce the incidence of postoperative complications.
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- 2020
43. Typical subdural contrast effusion secondary to endovascular treatment of a pediatric pial arteriovenous fistula
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Wen-Tao Yan, Jia-Chun Liu, Chang-Xiang Yan, and Xiu-Zhen Li
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medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Endovascular Procedures ,Infant ,Arteriovenous fistula ,medicine.disease ,Embolization, Therapeutic ,Subdural Effusion ,Cerebral Angiography ,Pediatric Vascular Diseases ,Hematoma ,Effusion ,Arteriovenous Fistula ,medicine ,Humans ,Contrast (vision) ,Female ,Radiology ,Endovascular treatment ,Child ,business ,Subdural effusion ,media_common - Abstract
Subdural contrast effusion secondary to endovascular treatment is exceptionally rare and might be mistaken as subdural hematoma because of similar hyperattenuation on computer tomography. The authors present the case of a 13-month-old girl with a history of increased head circumference and developmental retardation. Cerebral digital subtraction angiography showed a high-flow pial arteriovenous fistula fed by multiple arteries on the right cerebellar surface, with occlusion of the right sigmoid sinus and severe stenosis of the left sigmoid sinus. Staged endovascular treatments were performed to eliminate the fistula. Follow-up head computer tomography scans performed 3 h after both procedures demonstrated typical high-density subdural effusion with computer tomography attenuation value similar to hemorrhage. These effusions did not aggravate the condition and disappeared spontaneously 32 h after the first treatment and 29 h after the second, respectively.
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- 2020
44. Polycystic subdural hygroma associated with immunoglobulin G4-related intracranial hypertrophic pachymeningitis: a case report
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Ryu Yokoyama, Toshimasa Yamamoto, Hitoshi Kawasaki, Yoshihiko Nakazato, Risa Okuda, Naotoshi Tamura, and Kazumichi Ota
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Male ,medicine.medical_specialty ,Neurology ,Case Report ,lcsh:RC346-429 ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Immunoglobulin g4 ,Magnetic resonance imaging of the brain ,parasitic diseases ,medicine ,Humans ,Hypertrophic pachymeningitis ,Neurochemistry ,Meningitis ,030212 general & internal medicine ,IgG4-related disease ,lcsh:Neurology. Diseases of the nervous system ,medicine.diagnostic_test ,business.industry ,Headache ,Brain ,General Medicine ,Hypertrophy ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Subdural Effusion ,Subdural hygroma ,Immunoglobulin G ,Polycystic hygroma ,Neurology (clinical) ,Neurosurgery ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Background Recent studies have examined hypertrophic pachymeningitis as an IgG4-RD. However, there are no reports of immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis with polycystic subdural hygroma. Case presentation A 56-year-old man presented to the hospital with complaints of a persistent, pulsatile, occipital headache and general malaise. Magnetic resonance imaging of the brain revealed hypertrophic pachymeningitis with polycystic subdural hygroma and hematoma. Based on the dural biopsy findings and exclusion of other diseases, the patient was diagnosed with immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis. IgG4-related diseases may cause subdural hygroma more commonly than other diseases that cause hypertrophic pachymeningitis. Conclusions This is the first case report discussing polycystic subdural hygroma and hematoma with IgG4-related hypertrophic pachymeningitis.
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- 2020
45. Prediction of Risk Factors for the Evolution of Traumatic Subdural Effusion into Chronic Subdural Hematoma
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Lean Sun, Xiaochun Jiang, Hui Peng, Limin Cheng, Yi Dai, Jiongping Tian, Jie Liu, Xuefei Shao, Lin Yao, and Sansong Chen
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medicine.medical_specialty ,Univariate analysis ,Receiver operating characteristic ,business.industry ,Glasgow Coma Scale ,Brain Contusion ,Odds ratio ,medicine.disease ,Gastroenterology ,Confidence interval ,030227 psychiatry ,03 medical and health sciences ,0302 clinical medicine ,Effusion ,Internal medicine ,medicine ,business ,Subdural effusion ,030217 neurology & neurosurgery - Abstract
Purpose To explore the risk factors of the evolution of traumatic subdural effusion (TSE) into chronic subdural hematoma (CSDH). Materials and Methods The 70 patients' gender, age, location of effusion, unilateral and bilateral, Glasgow coma score (GCS) at admission, presence or absence of brain contusion, the time of effusion appeared, daily amount of mannitol, mannitol number of days used, with or without atorvastatin calcium tablets, with or without antiplatelet aggregation drugs, with or without anticoagulant drugs, with or without abnormalities in blood coagulation routines, computed tomography (CT) layer height, the thickness, and CT value of the first effusion were analyzed by single factor. Logistic multivariate regression analysis was performed on the statistically significant indicators. Power of the regression model was evaluated using receiver operating characteristic (ROC) curve. Results Univariate analysis showed that the presence or absence of brain contusion, the time of effusion appeared, atorvastatin calcium tablets use or not, the CT value of the effusion, and TSE into CSDH evolution varied significantly compared to the non-evolved group (P
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- 2020
46. Diabetic ketoacidosis (DKA) induced cerebral edema complicating small chronic subdural hematoma/hygroma/ at Zewuditu memorial hospital: a case report
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Mestet Yibeltal Shiferaw, Tsegazeab Laeke T/Mariam, Abenezer Tirsit Aklilu, Yemisirach Bizuneh Akililu, and Bethelhem Yishak Worku
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Burr hole ,Tight brain ,Adult ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,nutritional and metabolic diseases ,Case Report ,Chronic subdural hematoma/Hygroma ,Brain Edema ,General Medicine ,RC648-665 ,Diseases of the endocrine glands. Clinical endocrinology ,Subdural Effusion ,Diabetic Ketoacidosis ,Diabetes mellitus ,Hematoma, Subdural ,Humans ,Female ,Ethiopia ,Cerebral edema - Abstract
Background While 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 summary This 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. Conclusion DKA 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.
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- 2022
47. Conduta na lesão dural intraoperatória em artrodese da coluna lombar Conducta en lesión de duramadre intraoperatoria en artrodesis de la columna lumbar Management of intraoperatory dural tear in lumbar spine arthrodesis
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Fabiano de Mendonça Grandese, Clóvis Yamazato, Fábio Mastromauro de Oliveira, Iberê Ribeiro, José Olympio Catão Bastos Júnior, and René Kusabara
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Duramadre ,Efusión subdural ,Fusión vertebral ,Reoperación ,Cefalea ,Dura-Máter ,Derrame subdural ,Fusão vertebral ,Reoperação ,Cefaleia ,Dura Mater ,Subdural effusion ,Spinal fusion ,Reoperation ,Headache ,Orthopedic surgery ,RD701-811 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
OBJETIVO: estudo retrospectivo de pacientes com lesão dural intraoperatória de cirurgia da coluna vertebral lombar, conduzido por meio de um protocolo independente da extensão da lesão, complicações associadas e resultados após seguimento mínimo de um ano. MÉTODOS: um total de 10 pacientes com durotomia acidental em cirurgias de descompressão e artrodese da coluna vertebral lombar, no período de Janeiro de 2007 a Janeiro de 2009, para tratamento de doença degenerativa, tiveram seus prontuários revisados, após terem sido tratados por meio de um protocolo embasado em reparo primário da lesão, drenagem subaracnoidea fechada, subfascial e subcutânea aspirativa realizados por cirurgião experiente, associado a repouso relativo com mobilidade precoce e terapia medicamentosa. Suas anotações e exames radiológicos foram verificados com seguimento pós-operatório e direcionados para identificação de sintomas sugestivos de complicações. RESULTADOS: todos os pacientes apresentaram boa evolução, sem ocorrência de fístula liquórica ou infecção pós-operatória; três deles apresentaram cefaleia pós-operatória de leve intensidade. Não houve necessidade de reoperação em nenhum desses pacientes. CONCLUSÃO: concluiu-se que a conduta adotada é segura e de bom resultado para os pacientes quando ocorre esse tipo de lesão, independentemente da extensão da mesma.OBJETIVO: un estudio retrospectivo de pacientes con lesión de la duramadre intraoperatoria de cirugía en la columna lumbar, llevada a cabo por medio de un protocolo independiente de la extensión de la lesión, complicaciones asociadas y los resultados de seguimiento después de un mínimo de un año. MÉTODOS: 10 pacientes con durotomía accidental en la descompresión quirúrgica y artrodesis de la columna vertebral lumbar, en el período de enero de 2007 a enero de 2009, para el tratamiento de enfermedades degenerativas, tuvieron sus registros revisados después de tendieren sido tratados por un protocolo basado en la reparación primaria de la lesión, subaracnoidea drenaje cerrado, aspiración subfascial y subcutánea realizada por cirujanos con experiencia, combinada con el reposo relativo, con la movilización precoz y el tratamiento farmacológico. Sus notas y las imágenes fueron verificadas con el seguimiento postoperatorio y direccionadas para la identificación de síntomas sugestivos de complicaciones. RESULTADOS: todos los pacientes tuvieron buena evolución, sin registro de pérdidas de líquido cefalorraquídeo o infección postoperatoria, tres tuvieron cefalea en el postoperatorio de intensidad leve. No hubo necesidad de reintervención en esos pacientes. CONCLUSIÓN: la conducta adoptada es segura y con buen resultado para pacientes en los que este tipo de lesión se produce, independiente de la extensión de la misma.OBJECTIVE: a retrospective study of patients with spinal dural intraoperative lumbar spine surgery, conducted by means of a protocol regardless of the extent of the injury, associated complications and follow-up results after a minimum of one year. METHODS: a total of 10 patients with accidental durotomy in surgical decompression and arthrodesis of the lumbar spine during the period from January 2007 to January 2009 for treatment of degenerative disease had their records reviewed after being treated by a protocol based in primary repair of the lesion, closed subarachnoid drainage, subfascial and subcutaneous aspiration drainage performed by experienced surgeons, combined with relative rest with early mobilization and drug therapy. Their notes and imaging were verified with follow-up aimed to identify symptoms that could suggest complications. RESULTS: all patients had a good outcome, without occurrence of cerebrospinal fluid leaks or postoperative infection; three had postoperative headache of mild intensity. There was no need for reoperation in these patients. CONCLUSION: we concluded that the conduct adopted is safe and has a good outcome for patients when this type of injury occurs, regardless of its extent.
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- 2010
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48. Preoperative risk and postoperative outcome from subdural fluid collections in African infants with postinfectious hydrocephalus
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Vishal Monga, Jessica Lane, Jody Levenbach, Edith Mbabazi-Kabachelor, Peter Ssenyonga, Steven J. Schiff, Benjamin C. Warf, John Mugamba, Venkateswararao Cherukuri, Justin Onen, Joshua Harper, Ruth Donnelly, Paddy Ssentongo, Mallory R. Peterson, and Abhaya V. Kulkarni
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cautery ,Single Center ,Bayley Scales of Infant Development ,Ventriculoperitoneal Shunt ,Article ,law.invention ,Ventriculostomy ,Postoperative Complications ,Randomized controlled trial ,law ,Risk Factors ,Post-hoc analysis ,Medicine ,Humans ,Uganda ,business.industry ,Incidence ,Endoscopic third ventriculostomy ,Infant ,General Medicine ,medicine.disease ,Subdural Effusion ,Surgery ,Hydrocephalus ,Treatment Outcome ,Subdural hygroma ,Cauterization ,Female ,business - Abstract
OBJECTIVE This study investigated the incidence of postoperative subdural collections in a cohort of African infants with postinfectious hydrocephalus. The authors sought to identify preoperative factors associated with increased risk of development of subdural collections and to characterize associations between subdural collections and postoperative outcomes. METHODS The study was a post hoc analysis of a randomized controlled trial at a single center in Mbale, Uganda, involving infants (age < 180 days) with postinfectious hydrocephalus randomized to receive either an endoscopic third ventriculostomy plus choroid plexus cauterization or a ventriculoperitoneal shunt. Patients underwent assessment with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III; sometimes referred to as BSID-III) and CT scans preoperatively and then at 6, 12, and 24 months postoperatively. Volumes of brain, CSF, and subdural fluid were calculated, and z-scores from the median were determined from normative curves for CSF accumulation and brain growth. Linear and logistic regression models were used to characterize the association between preoperative CSF volume and the postoperative presence and size of subdural collection 6 and 12 months after surgery. Linear regression and smoothing spline ANOVA were used to describe the relationship between subdural fluid volume and cognitive scores. Causal mediation analysis distinguished between the direct and indirect effects of the presence of a subdural collection on cognitive scores. RESULTS Subdural collections were more common in shunt-treated patients and those with larger preoperative CSF volumes. Subdural fluid volumes were linearly related to preoperative CSF volumes. In terms of outcomes, the Bayley-III cognitive score was linearly related to subdural fluid volume. The distribution of cognitive scores was significantly different for patients with and those without subdural collections from 11 to 24 months of age. The presence of a subdural collection was associated with lower cognitive scores and smaller brain volume 12 months after surgery. Causal mediation analysis demonstrated evidence supporting both a direct (76%) and indirect (24%) effect (through brain volume) of subdural collections on cognitive scores. CONCLUSIONS Larger preoperative CSF volume and shunt surgery were found to be risk factors for postoperative subdural collection. The size and presence of a subdural collection were negatively associated with cognitive outcomes and brain volume 12 months after surgery. These results have suggested that preoperative CSF volumes could be used for risk stratification for treatment decision-making and that future clinical trials of alternative shunt technologies to reduce overdrainage should be considered.
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- 2021
49. Ruptured middle cranial fossa arachnoid cysts after minor trauma in adolescent boys presenting with subdural hygroma: two case reports
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Hidayatullah Hamidi and Mohammad Farouq Hamidi
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Male ,medicine.medical_specialty ,Adolescent ,Case Report ,Ruptured arachnoid cyst ,Middle cranial fossa ,Arachnoid cyst ,Hematoma ,medicine ,Humans ,Child ,Cranial Fossa, Middle ,business.industry ,General Medicine ,medicine.disease ,Minor head trauma ,Magnetic Resonance Imaging ,Intracranial Arachnoid Cysts ,Subdural Effusion ,Surgery ,body regions ,Arachnoid Cysts ,medicine.anatomical_structure ,Hematoma, Subdural ,Minor trauma ,Subdural hygroma ,Medicine ,business - Abstract
Background Intracranial 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 summary Authors 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. Conclusion Imaging work-up is necessary for symptomatic patients following minor head trauma as incidentally detected ruptured intracranial arachnoid cysts can be responsible for the symptoms.
- Published
- 2021
50. Development of subdural empyema from subdural effusion after suppurative encephalitis: A case report.
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Yang RX, Chen B, Zhang Y, Yang Y, Xie S, He L, and Shi J
- Abstract
Background: Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people. Herein, we report a patient misdiagnosed with subdural effusion, who was eventually diagnosed with chronic subdural empyema (SDE) caused by Streptococcus pneumoniae., Case Summary: A 63-year-old man was brought to our emergency room with a headache, vomiting, and disturbed consciousness. Computed tomography (CT) revealed a bilateral subdural effusion at the top left side of the frontal lobe. Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis, which improved after anti-infective therapy. However, the patient then presented with acute cognitive dysfunction and right limb paralysis. Repeat CT showed an increase in left frontoparietal subdural effusion, disappearance of the left lateral ventricle, and a shift of the midline to the right. Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae. His condition improved after adequate drainage and antibiotic treatment., Conclusion: Patients with unexplained subdural effusion, especially asymmetric subdural effusion with intracranial infection, should be assessed for chronic SDE. Early surgical treatment may be beneficial., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
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