Subdural hygroma accompanied by parenchymal and subarachnoid haemorrhage after epidural analgesia in an obstetric patient.

BACKGROUND: Anaesthetists need to know the different causes of persistent headache or a change in level of consciousness following epidural analgesia for labour. Failure to recognise these neurological complications can lead to delayed diagnoses, with subsequent serious implications. METHODS: We present a patient who was re-admitted for postural headache resulting from an unrecognised dural puncture during an epidural for pain relief while in labour. During the interview, the patient confirmed drug use (cocaine), so she was evaluated by a psychiatrist with possible post-partum psychosis or drug withdrawal syndrome. Afterwards, the patient deteriorated neurologically, showing impaired consciousness and seizures. RESULTS: The cranial computed tomography showed bilateral frontoparietal subdural collections with intraparenchymal and subarachnoid haemorrhaging. She improved by burr hole drainage of subdural hygroma and a blood patch. CONCLUSIONS: Neurological signs should alert the clinician to the possibility of subdural collection and other possible complications such as sinking of the brain in order not to delay the request for imaging tests for diagnoses and effective treatments.

[Dermoid cyst of the anterior fontanelle in children: clinical significance and differentiation from encephalocele]. / Quiste dermoide de la fontanela anterior en el niño: significado clínico y distinción del encefalocele.

Dermoid cysts of the anterior fontanel present as a tumor lesion that tenses up when the child cries or strains. Their midline position in the skull, the fact that some of these cysts contain clear fluid and the presence of an underlying bone defect, lead the clinician to the erroneous diagnosis of encephalocele, for which they are sent for consultation. We report a series of five of these cysts (3 dermoid and 2 epidermoid) located over the anterior fontanel, remark on their clinical significance, and stress their differential diagnosis from encephalocele and from other tumor lesions of the anterior fontanel.

[Walker-Warburg syndrome: experience at the Virgen de la Arrixaca Hospital]. / Síndrome de Walker-Warburg: experiencia del Hospital Virgen de la Arrixaca.

We report five patients with Walker-Warburg syndrome. These patients showed congenital hydrocephalus, encephalocele, agyria, ocular abnormalities (cataracts in 100%), and in four signs of muscular dystrophy. No cause is known for theses abnormalities. Death occurred before two years of age; however, one patient is currently alive with 6 months of age. This disease is recognized as a genetically determined condition with an autosomal recessive mode of inheritance. We comment on the similarities of this syndrome with other syndromes and the latest investigations concerning the pathogenesis. We believe that it is very important to suspect this illness in order that genetic counseling can be offered.

[Depressed skull fracture in the newborn infant. To operate or not?]. / Fractura con depresión craneal en el recién nacido. Operar o no operar?

In recent literature the question of the convenience of neurosurgical treatment of cranial depressed fracture of the newborn has been a subject of discussion. The authors review their experience with 4 cases of this condition, that stress the necessity of the operation. Most reported series have dealt with the short-term results of the different ways of treatment. In this article the outcome is evaluated at least 10 years after surgery.