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1.
J Med Case Rep ; 15(1): 511, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34635171

RESUMO

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. 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.


Assuntos
Cistos Aracnóideos , Derrame Subdural , Adolescente , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Criança , Fossa Craniana Média/diagnóstico por imagem , Hematoma Subdural , Humanos , Imageamento por Ressonância Magnética , Masculino , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/etiologia
3.
R I Med J (2013) ; 104(5): 40-43, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34044437

RESUMO

INTRODUCTION: Arachnoid cysts are a common incidental finding on head imaging. While the natural history of these cysts in poorly described, hemorrhage with subdural hygroma formation is rare. We review the clinical course of a patient who developed a subdural hygroma following trauma. CASE: The patient was a previously healthy 14-month-old male who presented to the Emergency Department with vomiting after a fall and was found to have esotropia without other focal neurological deficits and a CT scan consistent with a subdural cerebrospinal fluid collection with midline shift. The patient was treated conservatively and his symptoms resolved. DISCUSSION: Arachnoid cyst rupture is a rare complication which can lead to increased intracranial pressure with devastating consequences. Clinical manifestation can be similar to that of other intracranial pathologies. Prompt diagnosis is required to avoid life-threatening symptoms. CONCLUSION: Arachnoid cyst rupture should be considered when evaluating patients with non-specific neurological symptoms following trauma.


Assuntos
Cistos Aracnóideos , Derrame Subdural , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Encéfalo , Humanos , Lactente , Masculino , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/etiologia , Espaço Subdural , Tomografia Computadorizada por Raios X
4.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547096

RESUMO

A 34-year-old woman presented with an unrelenting headache which had been ongoing since discharge from hospital 4 days before. She initially presented 2 weeks earlier with a 7 days history of severe headache, for which she had a CT scan, lumbar puncture and treatment for possible viral meningitis. The headache got worse 4 days after the lumbar puncture. Despite analgesics and bed rest, the headache persisted. A subsequent magnetic imaging scan demonstrated bilateral subdural effusions. She was given supportive treatment, which included advice concerning strict bed rest and analgesia. The headache took several months to abate. A third of patients suffer from post lumbar puncture headaches and this should be explained during informed consenting and post procedure. Not all post lumbar puncture headaches are simple headaches. A post lumbar puncture headache continuing for more than 7-14 days after the procedure requires further investigation to exclude life-threatening intracranial complications.


Assuntos
Hipotensão Intracraniana/complicações , Cefaleia Pós-Punção Dural/etiologia , Punção Espinal/efeitos adversos , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/etiologia , Adulto , Analgésicos/uso terapêutico , Repouso em Cama , Diagnóstico Tardio , Feminino , Humanos , Cefaleia Pós-Punção Dural/terapia
5.
Acta Neurol Belg ; 121(2): 311-319, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33393068

RESUMO

A spinal subdural hygroma is a rare entity. In this review, we try to contribute to the pooling of current knowledge about spinal subdural hygroma, from embryology and physiology until radiological detection and treatment. The relevant articles in the literature regarding spinal subdural hygroma were reviewed, using a sensitive search strategy on Internet databases. A spinal subdural hygroma is associated with trauma, iatrogenic causes, spontaneous intracranial hypotension headache, and probably meningitis. MR imaging is the golden standard for diagnosis. Treatment of the hygroma is almost always conservative and surgery is seldom necessary, however treating the underlying cause is important. The physiology, in spite of numerous suggestions and hypotheses in literature, remains unclear. The prevalence of spinal subdural hygroma is also still unknown. Only a few articles deal with spinal subdural hygroma, because it is an uncommon entity, without specific symptoms. Probably it is often not diagnosed because of the frequent association with other cranial or spinal pathologies and the need for high-resolution imaging. More research is required to examine the prevalence, importance, and pathophysiology of spinal subdural hygroma.


Assuntos
Meningite/diagnóstico por imagem , Meningite/epidemiologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/epidemiologia , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/epidemiologia , Placa de Sangue Epidural/métodos , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/terapia , Humanos , Hipotensão Intracraniana/diagnóstico por imagem , Hipotensão Intracraniana/epidemiologia , Hipotensão Intracraniana/terapia , Imageamento por Ressonância Magnética/métodos , Meningite/terapia , Traumatismos da Medula Espinal/terapia , Derrame Subdural/terapia
6.
Childs Nerv Syst ; 37(4): 1307-1312, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33083873

RESUMO

PURPOSE: Surgical fenestration is widely accepted as a primary treatment for middle fossa arachnoid cysts (MFACs) in pediatric patients. However, postoperative subdural effusion and/or hydrocephalus always affect treatment outcomes. In this study, we presented our experience of treating MFACs with surgical fenestration in pediatric patients and analyzed the cases complicated by postoperative subdural effusion and/or hydrocephalus, to give insight into the clinical characteristics predisposing the complications. METHODS: We retrospectively analyzed 21 pediatric cases with MFACs treated by surgical fenestration suffering postoperative subdural effusion and/or hydrocephalus in our department from November 2011 to April 2019. We reviewed the clinical characteristics and treatment outcomes. RESULTS: A total of 21 patients, among a total of 53 pediatric patients with MFACs treated by surgical fenestration, developed subdural effusion and/or hydrocephalus postoperatively. The mean age at the time of the initial surgery was 49 months. A total of 75% (6/8) of the patients under 2 years old and 13.3% (6/45) of the older patient group sustaining postoperative subdural effusion and/or hydrocephalus required further surgeries, respectively (Fisher's exact test, p = 0.001). Notably, among the 21 cases with postoperative subdural effusion and/or hydrocephalus, all the 6 patients under 2 years old needed additional surgeries, while of the other 15 older patients, only 40% (6/15) needed further surgical interventions (Fisher's exact test, p = 0.019). CONCLUSION: The immature CSF absorption in MFAC patients younger than 2 years old might predispose them to the relatively serious postoperative subdural effusion and/or hydrocephalus. For very young patients with giant MFACs, surgical fenestration might not be the best option.


Assuntos
Cistos Aracnóideos , Hidrocefalia , Derrame Subdural , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Criança , Pré-Escolar , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Estudos Retrospectivos , Derrame Subdural/etiologia , Derrame Subdural/cirurgia , Resultado do Tratamento
8.
Neurosurg Rev ; 44(1): 129-138, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31845199

RESUMO

Post-traumatic hydrocephalus (PTH) is a potentially morbid sequela of decompressive craniectomy for traumatic brain injury (TBI). Subdural hygromas are commonly identified following decompressive craniectomy, but the clinical relevance and predictive relationship with PTH in this patient cohort is not completely understood. Survey of seven electronic databases from inception to June 2019 was conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Multivariate hazard ratios (HRs) for PTH by the presence of subdural hygroma were extracted and pooled by meta-analysis of proportions with random effects modeling. We systematically identified nine pertinent studies describing outcomes of 1010 TBI patients managed by decompressive craniectomy. Of the overall cohort, there were 211 (21%) females and median age was 37.5 years (range 33-53). On presentation, median Glasgow Coma Scale was 7 (range, 5-8). In sum, PTH was reported in 228/840 (27%) cases, and subdural hygroma was reported in 449/1010 (44%) cases across all studies. Pooling multivariate-derived HRs indicated that subdural hygroma was a significant, independent predictor of PTH (HR, 7.1; 95% CI, 3.3-15.1). The certainty of this association was deemed low due to heterogeneity concerns. The presence of subdural hygroma is associated with increased risk of PTH after decompressive craniectomy among TBI patients based on the current literature and may mandate closer clinical surveillance when detected. Prospective studies, including those of intracranial hydrodynamics following decompressive craniectomy in the setting of TBI, will better validate the certainty of these findings.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/métodos , Hidrocefalia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Derrame Subdural/cirurgia , Humanos , Hidrocefalia/complicações , Prognóstico , Derrame Subdural/complicações
9.
Br J Neurosurg ; 35(1): 1-6, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31992088

RESUMO

OBJECTIVE: Patients with subdural hygroma (SDG) are at increased risk of developing chronic subdural hematoma (CSDH). However, the factors that increase the risk of conversion are not fully understood. This study was to assess the risk factors of SDG conversion to CSDH. METHODS: We reviewed the literature and retrospectively studied a series of cases in which CSDH was preceded by SDG to understand the natural history. We reviewed 45 cases of SDG from our hospital between 2015 and 2018. The cases were divided into two groups according to whether SDG converted into CSDH. Data were collected clinical presentation, imaging findings et al. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SDG conversion. RESULTS: Univariate analysis showed that the SDG thickness (p = .009), SDG location (p = .026), and bilateral SDG (p = .042) were significantly associated with CSDH development. Multivariate analysis revealed that SDG thickness (odds ratio, 1.6; 95% confidence interval, 1.111-2.324; p = .012) and bilateral SDG (odds ratio, 27.6; 95% confidence interval 2.889-263.548; p = .004) were independent risk factors for SDG development. Receiver operating characteristic curve analysis revealed that SDG thickness was a significant variable for predicting SDG development. A thickness >11.37 mm was an appropriate cutoff value, and the possibility of SDG conversion had a sensitivity 50.0% and specificity of 87.0%. CONCLUSIONS: Bilateral SDG and SDG thickness were independent risk factors for SDG progression into CSDH. An SDG thickness >11.37 mm had a high risk of SDG conversion.


Assuntos
Hematoma Subdural Crônico , Derrame Subdural , Progressão da Doença , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/epidemiologia , Hematoma Subdural Crônico/etiologia , Humanos , Estudos Retrospectivos , Fatores de Risco
10.
J Int Med Res ; 48(11): 300060520966890, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33203286

RESUMO

Subdural effusion (SDE) is a common complication secondary to decompressive craniectomy (DC). This current case report describes a patient with contralateral SDE with a typical clinical course. Initially, he made a good recovery following a head trauma that caused a loss of consciousness and was treated with decompressive craniectomy. However, he only achieved temporary relief after each percutaneous fluid aspiration from an Ommaya reservoir implanted into the cavity of the SDE. He was eventually transferred to the authors' hospital where he underwent cranioplasty, which finally lead to the reduction and disappearance of his contralateral SDE. Unexpectedly, his clinical condition deteriorated again 2 weeks after the cranioplasty with symptoms of an uncontrolled bladder. A subsequent CT scan found the apparent expansion of the whole cerebral ventricular system, indicating symptomatic communicating hydrocephalus. He then underwent a ventriculoperitoneal shunt procedure, which resulted in a favourable outcome and he was discharged 2 weeks later. A review of the current literature identified only 14 cases of contralateral SDE that were cured by cranioplasty alone. The mechanism of contralateral SDE has been widely discussed. Although the exact mechanism of contralateral SDE and why cranioplasty is effective remain unclear, cranioplasty could be an alternative treatment option for contralateral SDE.


Assuntos
Craniectomia Descompressiva , Hidrocefalia , Derrame Subdural , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/etiologia , Derrame Subdural/cirurgia , Resultado do Tratamento
11.
Rozhl Chir ; 99(7): 316-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972150

RESUMO

INTRODUCTION: Decompressive craniectomy is an important method for managing refractory intracranial hypertension. Although decompressive craniectomy is a relatively simple procedure, various complications may arise. The aim of our paper was to determine the incidence of complications of decompressive craniectomy in patients with head injury and to analyse their risk factors. METHODS: We retrospectively analysed a group of 94 patients after decompressive craniectomy for head injury between 01 Jan 2014 and 31 Dec 2018. Postoperative complications were evaluated based on clinical examination and postoperative CT scan. The impact of potential risk factors on the occurrence of complications was assessed (age, worse initial clinical condition, any haemocoagulation disorder). RESULTS: Twenty patients died within the first month after surgery. Control CT scan showed one complication in 78 patients (83%), while 46 patients (49%) had more than one complication. We had to reoperate 22 patients (23.4%) due to a complication. The following complications were found: postoperative acute subgaleal/subdural haematoma (30× - 32%), subgaleal/subdural cerebrospinal fluid effusion (29× - 31%), soft tissues oedema (29× - 31%), haemorrhagic progression of brain contusion (17× - 18%), malignant brain oedema (8× - 8.5%), hydrocephalus (8× - 8.5%), temporal muscle atrophy (7× - 7.5%), peroperative massive bleeding ( 6× - 6.4%), epilepsy (4× - 4.3%), syndrome of the trephined (2× - 2.1%), skin necrosis (2× - 2.1%). Patients with a haemocoagulation disorder had a significantly higher incidence of complications (p=0.01). CONCLUSION: Complications of decompressive craniectomy after head injury are frequent. The potential benefit of decompressive craniectomy can be adversely affected by the occurrence of many complications.


Assuntos
Lesões Encefálicas , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Craniectomia Descompressiva/efeitos adversos , Derrame Subdural/cirurgia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
12.
World Neurosurg ; 144: e178-e188, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32805463

RESUMO

OBJECTIVE: This article discusses the procedure of foramina magnum and Magendie dredging, summarizing the pathologic changes in the intradural region of the craniocervical junction in patients with syringomyelia and the pathophysiologic mechanism of cerebrospinal fluid (CSF) circulation obstruction. METHODS: Clinical data from 50 adult patients with syringomyelia treated at Xuanwu Hospital from July 2018 to January 2019 were collected and retrospectively analyzed. All operations were performed with foramina magnum and Magendie dredging, and all intradural factors that may have induced the obstruction of CSF circulation were recorded. RESULTS: Intradural pathology was found in all patients. The pathologic changes that may have caused obstruction of the CSF circulation include tonsil occupying the foramen magnum and overlying foramen of Magendie in 88% (44/50), intertonsillar arachnoid adhesions in 36% (18/50), tonsil to medulla arachnoid adhesions in 18% (9/50), medialized tonsils in 70% (35/50), vermian branch of posterior inferior cerebellar artery in 22% (11/50), arachnoid veil in 16% (8/50), cisterna magna cyst in 4% (2/50), and tonsil to dura mater arachnoid adhesions in 8% (4/50). Mean duration of follow-up was 13.3 months. The long-term effective rate was 96.0%. Postoperative magnetic resonance imaging revealed that the size of the syringomyelia was reduced or completely resolved in 88% of patients. The mean preoperative Japanese Orthopaedic Association score was 12.9 ± 3.1, which improved to 14.7 ± 3.2 (P < 0.05) at last clinical follow-up. CONCLUSIONS: Intradural pathology that causes CSF circulation obstruction exists in many forms. Relieving the obstruction of the foramen magnum and foramen of Magendie is key to surgical treatment.


Assuntos
Forame Magno/patologia , Forame Magno/cirurgia , Procedimentos Neurocirúrgicos/métodos , Derrame Subdural/patologia , Derrame Subdural/cirurgia , Siringomielia/patologia , Siringomielia/cirurgia , Adolescente , Adulto , Idoso , Aracnoide-Máter/patologia , Artérias Cerebrais/patologia , Descompressão Cirúrgica , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
J Infect Chemother ; 26(10): 1090-1094, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32646818

RESUMO

Meningitis is associated with elevated levels of inflammatory cytokines in the blood, cerebrospinal fluid (CSF), and subdural fluid. Subdural effusion prolongs fever in patients with meningitis. However, the reason for this remains unclear. A healthy one-month-old boy was admitted after presenting with bacterial meningitis. He was administered meropenem, cefotaxime, and dexamethasone intravenously. On the 3rd day, blood and CSF cultures revealed the presence of Group B Streptococcus from samples collected on day 1. Subsequently, ampicillin and gentamicin replaced the previous combination of antimicrobials used. On the 4th day, brain magnetic resonance imaging with contrast showed bilateral cerebral ventriculitis and left subdural effusion. On the 11th day, since the subdural effusion had worsened, we performed a subdural puncture from the anterior fontanelle. Owing to the prolonged fever, he was intravenously injected immunoglobulin on day 13. He was afebrile on day 23. Antimicrobials were administered for 28 days. Levels of interleukin-6 (IL-6) in the serum and CSF were the highest on the 1st day at 20,600 pg/mL and 170,000 pg/mL, respectively, and decreased upon treatment. IL-6 concentration in the subdural fluid (30,000 pg/mL) was much higher than that in the serum (9 pg/mL) and CSF (2600 pg/mL). To the best of our knowledge, this is the first report on the cytokines in subdural fluid in patients with group B Streptococcal meningitis. Subdural effusion maintained high levels of IL-6 even after the levels in the blood and CSF decreased dramatically. This could explain why subdural effusion prolongs fever in patients with meningitis.


Assuntos
Meningites Bacterianas , Infecções Estreptocócicas , Derrame Subdural , Humanos , Lactente , Interleucina-6 , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Streptococcus agalactiae
14.
Rinsho Shinkeigaku ; 60(8): 538-542, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641629

RESUMO

A 78-year-old woman with bilateral fungal sinusitis, which resulted in right orbital apex syndrome, underwent endoscopic sinus surgery and optic nerve decompression. Two months after the operation, she complained of anxiety and insomnia. Head CT showed subdural hematoma-like effusion and burr hole drainage was conducted. The collected fluid was not hematoma, but bloody, xanthochromic effusion with no pathogenic bacteria. Ten days later, she underwent drainage and dural biopsy after craniotomy because of relapse of subdural hygroma and progression of hypertrophic pachymeningitis associated with aggravation of psychiatric symptoms. A sample of the dura mater showed dense fibrosis with thickening, and Pseudomonas aeruginosa (P. aeruginosa) was detected by culture. Although otitis or sinusitis secondary to P. aeruginosa infection has been reported as a leading cause of infectious pachymeningitis, psychiatric symptoms alone and concomitant refractory subdural hygroma are atypical and unreported manifestations. In patients with pachymeningitis and a history of transnasal endoscopic surgery, P. aeruginosa infection should be considered, irrespective of an atypical clinical course and negative blood or fluid culture. Additionally, dural biopsy might help in detection of pathogenic bacteria.


Assuntos
Meningite/complicações , Meningite/microbiologia , Infecções por Pseudomonas , Derrame Subdural/etiologia , Doença Aguda , Administração Oral , Idoso , Feminino , Humanos , Levofloxacino/administração & dosagem , Meningite/terapia
15.
JBJS Case Connect ; 10(2): e0102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649092

RESUMO

CASE: Two cases of postoperative spinal subdural extra-arachnoid hygromas were successfully treated with bed rest after patients developed symptoms 4 to 5 days following decompressive lumbar surgery. The development of the hygromas as well as the radiological findings are discussed. CONCLUSION: To the best of our knowledge, these comprise the first postoperative cases successfully treated without surgical re-exploration. This demonstrates conservative management may be a safe and effective management choice.


Assuntos
Descompressão Cirúrgica , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Fusão Vertebral , Derrame Subdural/etiologia , Idoso , Repouso em Cama , Tratamento Conservador , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/terapia
16.
BMC Neurol ; 20(1): 228, 2020 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-32498716

RESUMO

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.


Assuntos
Encéfalo/diagnóstico por imagem , Meningite/complicações , Derrame Subdural/etiologia , Cefaleia/etiologia , Humanos , Hipertrofia , Imunoglobulina G/imunologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
17.
Fa Yi Xue Za Zhi ; 36(2): 223-228, 2020 Apr.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32530171

RESUMO

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<0.05). The differences in depression and hostility factor scores between males and females had statistical significance (P<0.05). The differences in compulsion, anxiety and terror factor scores and total mean scores among different age groups had statistical significance (P<0.05). The differences in hostility, paranoia and psychosis factors among patients with different degrees of education had statistical significance (P<0.05). The differences in depression, anxiety, hostility and terror factor scores and total mean scores among single-site group, double-site group and multi-site group had statistical significance (P<0.05). The differences in somatization, depression and anxiety factor scores and total mean scores between the right cerebral hemisphere group and the left cerebral hemisphere group and bilateral hemisphere group had statistical significance (P<0.05). Conclusion Traumatic subdural effusion can cause certain psychological changes, which are related to the primary trauma of arachnoid tear as well as the number and location of effusion sites. Attention should be paid to the influence of the above factors during the assessment of psychological symptoms.


Assuntos
Derrame Subdural , Ansiedade , Depressão , Transtorno Depressivo , Feminino , Humanos , Masculino , Inquéritos e Questionários
18.
J Clin Neurosci ; 78: 273-276, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402617

RESUMO

Subdural hygroma (SDG) represents a common complication following decompressive craniectomy (DC). To our knowledge we present the first meta-analysis investigating the role of clinical and technical factors in the development of SDG after DC for traumatic brain injury. We further investigated the impact of SDG on the final prognosis of patients. The systematic review of the literature was done according to the PRISMA guidelines. Two different online medical databases (PubMed/Medline and Scopus) were screened. Four articles were included in this meta-analysis. Data regarding age, sex, trauma dynamic, Glasgow Coma Scale (GCS), pupil reactivity and CT scan findings on admission were collected for meta-analysis in order to evaluate the possible role in the SDG formation. Moreover we studied the possible impact of SDG on the outcome by evaluating the rate of patients dead at final follow-up and the Glasgow Outcome Scale (GOS) at final follow-up. Among the factors available for meta-analysis only the basal cistern involvement on CT scan was associated with the development of a SDG after DC (p < 0.001). Moreover, patients without SDG had a statistically significant better outcome compared with patients who developed SDG after DC in terms of GOS (p < 0.001). The rate of patients dead at follow-up was lower in the group of patients without SDH (8.25%) compared with patients who developed SDG (11.51%). SDG after DC is a serious complication affecting the prognosis of patients. Further studies are needed to define the role of some adjustable technical aspect of DC in preventing such a complication.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/efeitos adversos , Craniectomia Descompressiva/tendências , Complicações Pós-Operatórias/diagnóstico por imagem , Derrame Subdural/diagnóstico por imagem , Escala de Coma de Glasgow/tendências , Escala de Resultado de Glasgow/tendências , Humanos , Complicações Pós-Operatórias/etiologia , Derrame Subdural/etiologia , Tomografia Computadorizada por Raios X/tendências
20.
Childs Nerv Syst ; 36(9): 2073-2078, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32062780

RESUMO

PURPOSE: Rupture of arachnoid cysts (AC) in the subdural space after trauma may cause a subacute/chronic subdural hematoma or a hygroma. Treatment of this complication still remains controversial, and no consensual strategy is to date clearly proposed. In this study, the authors evaluated the clinical and radiological evolution of patients treated by a subduro-peritoneal shunt for symptomatic subdural collections complicating ruptured AC. METHODS: Medical records of the 10 patients treated at our institution between January 2005 and December 2018 for a subdural collection associated with an intracranial AC were reviewed. Subduro-peritoneal shunts consisted of low-pressure valves from 2005 to 2012 (6 cases) and medium-pressure valves after 2012 (4 cases). RESULTS: A benign head trauma was retrospectively found in the history of 8 patients. The mean time to diagnosis ranged from 15 days to 5 months. Symptoms resulted mainly from intracranial hypertension. Six patients had an ipsilateral hygroma to the AC, 2 patients had a bilateral hygroma predominantly to the AC side, and 2 patients presented an ipsilateral chronic subdural hematoma. Arachnoid cysts were classified as Galassi I in 5 cases and Galassi II in 5 cases. Patients with chronic subdural hematoma were given a medium-pressure valve. Patients with subdural hygroma received a low-pressure valve in 6 cases and a medium-pressure valve in 2 cases. There were no complications during surgical procedures. All patients were rapidly free of symptoms after surgery and were discharged from hospital 1 to 4 days postoperatively. The subdural collection completely disappeared in all cases. In the long term, only 2 patients with low-pressure valves underwent shunt removal without any consequences, while a second surgical procedure was necessary to treat recurrence of intracranial hypertension in the 4 remaining cases. All the medium-pressure valves were removed without problems. The size of the AC was reduced in 3 cases, remained stable in 4 cases, and increased in 3 cases. No patients experienced recurrence of subdural collection during follow-up. CONCLUSIONS: Medium-pressure subduro-peritoneal shunts should be considered as part of the arsenal of surgical strategy in symptomatic ruptured AC in the subdural space. The procedure is simple with a very low morbidity, and it allows rapid improvement of symptoms. Although the shunt is located in the subdural space, we strongly recommend avoiding devices which may create an overdrainage and expose the patient to shunt dependency such as low-pressure shunts.


Assuntos
Cistos Aracnóideos , Derrame Subdural , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Criança , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Derrame Subdural/diagnóstico por imagem , Derrame Subdural/etiologia , Derrame Subdural/cirurgia , Espaço Subdural
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