Cases reported "Subdural Effusion"

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1/44. Treatment of a symptomatic posterior fossa subdural effusion in a child.

    We describe the first observation of a child with a posterior fossa subdural effusion with secondary hydrocephalus and tonsillar herniation. We diagnosed this entity in a 14-month-old girl with no history of trauma or coagulation disorder. The patient presented in our emergency department with opisthotonus and raised intracranial pressure resulting from supratentorial hydrocephalus. An emergency ventriculo-peritoneal shunt was placed, which resolved the symptoms only temporarily. Eventually external drainage of the subdural fluid was performed. The collection gradually disappeared, and both the external subdural shunt and the ventriculo-peritoneal shunt were removed. The patient made a complete neurological recovery. We review the physiopathology and treatment of subdural effusions in general, and propose some guidelines for the management of symptomatic effusions occurring in the posterior fossa in particular.
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2/44. Simultaneous subdural effusion and hydrocephalus in infancy.

    hydrocephalus and subdural hematoma or effusion of infancy rarely present simultaneously, where both are active contributors to acutely increased intracranial pressure. In three cases, clinical findings characteristic of both were present. decompression of one can facilitate expansion of the other. Rapid progression of unsuspected hydrocephalus could be responsible for some of the poor results reported after treatment of subdural effusion alone. This possibility should be considered whenever progress is unsatisfactory during treatment of subdural effusion.
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3/44. Hemorrhagic subdural effusion complicating an endoscopic III ventriculostomy.

    subdural effusion, a common postoperative complication of extracranial shunting for hydrocephalus, is usually caused by excessive drainage of cerebrospinal fluid. subdural effusion is thought to occur less frequently after a neuroendoscopic III ventriculostomy, and no reported cases have been symptomatic. We encountered a symptomatic subdural effusion with a component of hemorrhage 5 days after the latter procedure was performed to treat massive hydrocephalus in a 2-year-old boy.
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4/44. Bilateral subdural effusion and subcutaneous swelling with normally functioning csf shunt.

    We report a child with hydrocephalus due to tuberculous meningitis who developed a subcutaneous fluid collection around the ventriculoperitoneal shunt tube entry point, after one month of shunting. On investigation, he had decompressed ventricles with bilateral fronto parietal subdural hygroma. Bifrontal burr hole drainage helped resolution of both subdural effusion and subcutaneous scalp swelling. This complication is unique and its pathogenesis has been postulated.
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5/44. Cerebral cysticercus granuloma associated with a subdural effusion.

    The association of a solitary cerebral cysticercus granuloma with a subdural effusion is being reported. The granuloma and the effusion resolved following albendazole therapy. We speculate that the spread of the inflammatory changes around the granuloma to the subdural space could have led to the development of the subdural effusion.
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6/44. Bilateral subdural effusions related to disease activity in familial hemophagocytic lymphohistiocytosis in an 8-month-old infant.

    An 8-month-old girl had classic features of hemophagocytic lymphohistiocytosis (HLH). A presumptive diagnosis of familial hemophagocytic lymphohistiocytosis was made on the basis of her age and the presence of parental consanguinity. In view of abnormal neurologic findings at presentation, a magnetic resonance imaging scan was performed and showed bilateral proteinaceous subdural effusions. These resolved within 1 week of commencement of chemotherapy for the primary condition. These subdural effusions were the only objective documentations of central nervous system involvement, along with an increased cerebrospinal fluid protein level. We also report other radiologic findings of HLH, which are of use in strengthening this diagnosis in individuals in whom the diagnosis is strongly suspected.
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7/44. Aspirating subdural effusions, so called brain stem shock.

    A shift of blood into the head during negative pressure aspiration of subdural haematomas in an infant has been demonstrated, and also that aspiration may restart bleeding. An estimate of the elasticity of a 47 cm circumference skull has been obtained. It is suggested that the observed changes in distribution of blood are sufficient to explain the occasional deaths of infants after aspiration of subdural haematomas and that so-called "brain stem shock" need not be invoked.
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8/44. Intracranial salmonella infections: meningitis, subdural collections and brain abscess. A series of six surgically managed cases with follow-up results.

    Focal intracranial infections due to Salmonella are rare. So far, around 80 cases have been reported in the world literature. The authors present their experience of 6 cases of intracranial salmonella infections, mainly subdural empyema in 5 and effusion in 1. In 1 case, subdural empyema was bilateral, and in another case, there was an associated brain abscess. Positive blood cultures and positive Widal tests were noticed in 2 patients each. early diagnosis and prompt evacuation of subdural collections and brain abscess and antibiotic therapy lead to satisfactory results. This study suggests that a high index of suspicion, early diagnosis and quick evacuation lead to success; this point is highlighted with the help of a review of the literature.
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9/44. haemophilus influenzae type b meningitis with subdural effusion: a case report.

    haemophilus influenzae type b causes invasive infection in children under 2 years of age. The disease may be complicated with hearing impairment, lowered learning ability, and other neurologic sequelae. The incidence of invasive H. influenzae type b has declined dramatically after the introduction of routine administration of protein-conjugated H. influenzae type b vaccine in the united states and some other countries. Because of its low incidence in taiwan, many clinicians are not familiar with the initial symptoms and management of H. influenzae type b. This case report describes a 7-month-old H. influenzae type b meningitis patient who had initial presentations of prolonged intermittent fever and vague neurologic signs. Left peripheral facial palsy with hearing loss in left ear and bilateral frontal subdural effusion developed during the first 5 days of cefotaxime therapy. betamethasone was then given for 4 days to relieve the severe inflammation. Drug-induced fever was observed after 11 days of antibiotic use and subsided with prednisolone treatment. Left ear hearing impairment persisted during the follow-up period, but the children did not experience other significant development delay.
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10/44. Bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension: diagnostic and management strategies. Report of two cases.

    The authors describe two patients with bilateral subdural effusion and cerebral displacement associated with spontaneous intracranial hypotension (SIH) and discuss the possible pathophysiological origins of these abnormalities. The signs seen on magnetic resonance imaging in both cases, such as tonsillar descent, subdural effusion, meningeal enhancement, downward displacement of the optic chiasm, and crowding of this structure and the hypothalamus between the pituitary gland and brain, can help to establish the diagnosis of SIH. Therapy with a lumbar epidural blood patch resulted in the rapid resolution of all symptoms and most morphological abnormalities. The authors propose diagnostic and management strategies based on their own experiences and the reported cases of SIH in the medical literature.
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