subdural hygroma

Subdural hygroma
	Subdural hygroma, frontal and temporal. Man of 80 years old.
Classification and external resources
Specialty	cardiology
ICD-10	I62.0
ICD-9-CM	674.0
	[edit on Wikidata]

硬膜下水腫

WordNet

below the dura mater but above the arachnoid membrane of the meninges

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/15 22:15:20」(JST)

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A subdural hygroma is a subdural body of cerebrospinal fluid (CSF), without blood. Most subdural hygromas are believed to be derived from chronic subdural hematomas. It is commonly seen in elderly patients after minor trauma but can be seen in children after an infection. One of the common causes of subdural hygroma is a sudden decrease in pressure by ventricular shunting. This can lead to leakage of CSF into the subdural space especially in cases with moderate to severe brain atrophy. In these cases the symptoms such as mild fever, headache, drowsiness and confusion can be seen, which are relieved by draining this subdural fluid.

Signs and symptoms

Most subdural hygromas are small and clinically insignificant. Larger hygromas may cause secondary localized mass effects on the adjacent brain parenchyma, enough to cause a neurologic deficit or other symptoms. Acute subdural hygromas can be a potential neurosurgical emergency, requiring decompression. Acute hygromas are typically a result of head trauma—they are a relatively common posttraumatic lesion—but can also develop following neurosurgical procedures, and have also been associated with a variety of conditions, including dehydration in the elderly, lymphoma and connective tissue diseases.

Diagnosis

In the majority of cases, if there has not been any acute trauma or severe neurologic symptoms, a small subdural hygroma on the head CT scan will be an incidental finding. If there is an associated localized mass effect that may explain the clinical symptoms, or concern for a potential chronic SDH that could rebleed, then an MRI, with or without neurologic consultation, may be useful.

It is not uncommon for chronic subdural hematomas (SDHs) on CT reports for scans of the head to be misinterpreted as subdural hygromas, and vice versa. Magnetic resonance imaging (MRI) should be done to differentiate a chronic SDH from a subdural hygroma, when clinically warranted. Elderly patients with marked cerebral atrophy, and secondary widened subarachnoid CSF spaces, can also cause confusion on CT. To distinguish chronic subdural hygromas from simple brain atrophy and CSF space expansion, a gadolinium-enhanced MRI can be performed. Visualization of cortical veins traversing the collection favors a widened subarachnoid space as seen in brain atrophy, whereas subdural hygromas will displace the cortex and cortical veins.

References

Taveras, Juan M. et al., eds. Radiology: Diagnosis, Imaging, Intervention. 1994- ISBN 0-397-57115-1; ch. 37: 9-13.
Brain Inj 1998 Jul;12(7):595-603.
McCluney KW, Yeakley JW, Fenstermacher MJ, et al. «Subdural hygroma versus atrophy on MR brain scans: "the cortical vein sign"». AJNR Am J Neuroradiol 1992;13: 1335–39.

UpToDate Contents

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1. 成人における硬膜下血腫：病因、臨床的特徴、および診断 subdural hematoma in adults etiology clinical features and diagnosis
2. 成人における硬膜下血腫：予後およびマネージメント subdural hematoma in adults prognosis and management
3. 小児における硬膜下血腫：疫学、解剖学、および病態生理 intracranial subdural hematoma in children epidemiology anatomy and pathophysiology
4. 小児における硬膜下血腫：臨床的特徴、評価、およびマネージメント intracranial subdural hematoma in children clinical features evaluation and management
5. Intracranial epidural abscess

English Journal

Dengue fever with diffuse cerebral hemorrhages, subdural hematoma and cranial diabetes insipidus.

Jayasinghe NS1, Thalagala E2, Wattegama M2, Thirumavalavan K2.
BMC research notes.BMC Res Notes.2016 May 10;9(1):265. doi: 10.1186/s13104-016-2068-5.
BACKGROUND: Neurological manifestations in dengue fever occur in <1 % of the patients and known to be due to multisystem dysfunction secondary to vascular leakage. Occurrence of wide spread cerebral haemorrhages with subdural hematoma during the leakage phase without profound thrombocytopenia a
PMID 27165581

Methods of intra-operative treatment of cranioplasty in patients with abnormal bone window flap pressure after decompressive craniectomy.

Wan Y1, Fei X1, Shi L2, Jiang D1, Chen H1, Wang Z3, Zeng Y4.
Clinical neurology and neurosurgery.Clin Neurol Neurosurg.2016 May;144:44-7. doi: 10.1016/j.clineuro.2016.03.001. Epub 2016 Mar 6.
OBJECTIVE: This study was performed to investigate the method of cranioplasty in patients with abnormal bone window pressure after decompressive craniectomy.METHODS: We performed a retrospective analysis for 25 cases after decompressive craniectomy in patients with abnormal flap pressure of clinical
PMID 26971294

Paradoxical Brain Herniation After Decompressive Craniectomy Provoked by Drainage of Subdural Hygroma.

Nasi D1, Dobran M2, Iacoangeli M2, Di Somma L2, Gladi M2, Scerrati M2.
World neurosurgery.World Neurosurg.2016 Apr 20. pii: S1878-8750(16)30168-1. doi: 10.1016/j.wneu.2016.04.041. [Epub ahead of print]
BACKGROUND: Paradoxical brain herniation (PBH) is a rare and potentially life-threatening complication of decompressive craniectomy (DC) and results from the combined effects of brain gravity, atmospheric pressure and intracranial hypotension causing herniation in the direction opposite to the site
PMID 27108031

Japanese Journal

Subacute Subdural Hygroma and Presyrinx Formation After Foramen Magnum Decompression With Duraplasty for Chiari Type 1 Malformation : Case Report

SUZUKI Fumio,KITAGAWA Tadashi,TAKAGI Kenji,NOZAKI Kazuhiko
Neurologia medico-chirurgica = 神経外科 51(5), 389-393, 2011-05-15
… A 15-year-old girl developed a rare case of subdural hygroma after foramen magnum decompression for Chiari type 1 malformation manifesting as rapid symptom deterioration around 10 days after uncomplicated operation with uneventful immediate postoperative course. … Progressive enlargement of the subdural hygroma in both supra- and infratentorial spaces was followed by the development of hydrocephalus. …
NAID 10029138056

Clinical features and subdural lesions in childhood onset Haemophilus influenzae meningitis

Imataka George,Yoshida Atsushi,Tsukada Keiko,Koyama Satomi,Shimura Naoto,Fukushima Keitaro,Arisaka Osamu
Dokkyo journal of medical sciences 37(3), 173-180, 2010-10-25
… We investigated the clinical featuresof Hib meningitis with subdural lesions. … MRI showed subdural hygroma in 4 patients and subdural abscess in 4 patients.Subdural lesions appeared on Day 1 to Day 18 from the onset. …
NAID 110007860935

Arachnoidplasty for Traumatic Subdural Hygroma Associated With Arachnoid Cyst in the Middle Fossa : Case Report

HASEGAWA Yuzuru,TANAKA Toshihide,KATO Naoki,KAKU Shougo,ARAI Takao,ABE Toshiaki
Neurologia medico-chirurgica = 神経外科 50(8), 698-701, 2010-08-15
… Computed tomography (CT) showed subdural hygroma. … However, recollection of subdural hygroma was found on follow-up CT 3 weeks after subdural drainage. … Arachnoidplasty was effective for traumatic subdural hygroma with arachnoid cyst for reconstruction. …
NAID 10026651614

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