Background: Subdural hygroma (SDHy) is a collection of cerebrospinal fluid (CSF) under the dural membrane. The chronic SDH has a special position (see below: “Chronic Subdural Hematoma”). Traumatic subdural hygromas: proposed pathogenesis based classification. Lee KS. These rapid movements result in repeated acceleration and deceleration of the child's head due to missing postural control. As long as no harmonization of terminology, methodology, and age diagnostic criteria of SDCs exists and as long as the scientific data situation has not improved, only rough time-related statements on SDCs will be possible. Subdural hygromas generally occur along the supratentorial cerebral convexities;Â occurrence in the posterior fossa is rare 4. arachnoid cyst with subdural hygroma. However, the large body of literature allows the differentiation of at least the following 6 entities. Spinal trauma such as ligamentous injuries at the craniocervical junction, or spinal sub- or epidural hematomas. Subdural hematoma (SDH) and epidural hematoma are characterized by bleeding into the spaces surrounding the brain. Subdural hygroma versus atrophy on MR brain scans: "the cortical vein sign". In addition to more reference data, a harmonization of terminology and methodology is urgently needed, especially with respect to age-diagnostic aspects. Benign external hydrocephalus (BEH), hygroma and chronic subdural haematoma are extraâaxial fluid collections in infants. However, some symptoms uncommonly reported include 5: The pathogenesis of subdural hygromas is not entirely understood. These proteinaceous SDC entities are predominantly considered sequelae (in case of subdural effusion [SDE]) or complications (in case of subdural empyema [SDEm], eg, due to an infected SDE) of bacterial meningitis or sinusitis.22,39 These conditions usually do not cause diagnostic difficulties because inflammatory symptomatology or a history of CNS infection is typically present. At least 4 different scenarios have been proposed as explanations for the mixed-density pattern, and 3 of them may be deduced from only 1 single traumatic event (Table 2, upper part).22,28, Scenario 4 (“acute-on-chronic” variant in Table 2) can often be excluded when an acute severe shaking event is suspected because acute rebleeding from cSDH-associated neomembranes is not associated with the typical acute symptomatology of AHT.22,24 Then, additional MR imaging and serial neuroimaging may provide more information.68,69. Post-operative intra-spinal subdural collections after pediatric posterior fossa tumor resection: Incidence, imaging and clinical features Julie H Harreld , 1 Noryati Mohammed , 2 Grant Goldsberry , 3 Xingyu Li , 4 Yimei Li , 4 Frederick Boop , 5 and Zoltan Patay 1 TIS. To this end, repeated cranial imaging investigations (serial neuroimaging) are required, as long as the clinical state of the patient allows these procedures.22,31,69,70. 2008;64 (3): 705-13. 18 (4): 351-8. Mixed-density and hypodense SDCs—2 typical problem constellations during the initial CT investigationa, Currently, from the pathophysiologic point of view, chronic subdural hematoma (cSDH) is considered a separate SDC entity.23 cSDH denotes a serosanguinous, petroleum-, or crankcase-like fluid collection surrounded and sometimes loculated (divided into compartments) by neomembranes (Fig 1G, -I).26,33⇓–35 Neomembranes contain numerous new blood vessels leading to accumulation of contrast agent in neuroimaging studies.22,27 The presence of neomembranes represents an important criterion for distinguishing cSDH and SDHy. The principle is as follows: If a stage X (eg, “chronic”) is found, according to available study data, a minimum time Y (eg, 2 weeks) has elapsed since the trauma has occurred. A subdural hygroma radiographically appears as a crescentic near-CSF density/signal accumulation in the subdural space that does not extend into the sulci and rarely exerts significant mass-effect 5. -, 5. While the former is compatible with both a rapid and a delayed process, the latter, in fact, suggests a traumatic event that occurred weeks ago. Approximately 50 BVs (diameter, 0.05–3.07 mm) connect the cortical veins of the cerebral and cerebellar surface with the large venous sinuses, thereby penetrating the inner part of the dura mater.41 Typically, injuries of the BVs cause extra-axial hemorrhage, predominantly within the subarachnoid and subdural spaces.23,41⇓⇓–44. However, the application of a “minimum age concept” might be an improvement towards an age-diagnostic assessment of the SDC, despite overlapping time intervals of stages. Kim et al. Note the different signal intensities and multiple fluid-fluid levels within subdural chamber formations, especially in the right occipital region. We do not capture any email address. MRI (magnetic resonâ¦ Neurosurgery. INTRODUCTION. Subdural fluid collections (SFCs) may be either a hygroma (i.e. In cases where mass-effect is radiographically demonstrated, it may be neurosurgically evacuated 5.Â. A subdural hygroma (SDG) is a collection of cerebrospinal fluid (CSF), without blood, located under the dural membrane of the brain. Green indicates the dura mater; orange, the arachnoid membrane; the space in between, the subdural space; hom., homogeneous; het., heterogeneous; t, time; R, resorption/resolution. An acute subdural hygroma results from the acute accumulation of CSF within the dural border cell layer. This can lead to leakage of CSF into the sâ¦ However, such statements may be helpful if a “minimum age concept” is applied. Spontaneous rupture of an arachnoid cyst resulâ¦ Coronal T2-weighted MR image shows bilateral subdural hygromas with a normal-appearing bridging vein (arrow) traversing the subdural hygroma on the right. Indicates open access to non-subscribers at www.ajnr.org. While the frontoparietal SDC proportions appear hypointense, the parietooccipital proportions are iso- to hyperintense. 4. ISBN:B005R1PB8S. Subdural hematohygromas (SDHHys) are a combination of blood (or blood products) and CSF (or CSF-like fluid).22,28⇓–30 A homogeneous and a heterogeneous variant can be differentiated. Apart from the clinical and medicolegal significance for the diagnosis of child abuse, SDCs may also be relevant for criminological aspects because age estimation possibly facilitates further limitation of the circle of suspects. Other potential pathogenic mechanisms for posttraumatic low attenuation subdural fluid include a hygroma due to a tear in the arachnoid membrane, 6 an effusion from traumatized meninges, 7,8 and a hyperacute hematoma with fresh unclotted blood or areas of unretracted semiliquid clot. AJNR Am J Neuroradiol. Key Words subdural hematoma, subdural hygroma, intracranial hemorrhage Introduction The accurate age determination of a subdural hemorrhage is one of the most common and basic assessments in the setting of head trauma. CT and MR imaging represent important tools for the diagnosis of abusive head trauma in living infants. Normally, SDEs and SDEms are nontraumatic, but in rare cases, SDEms may originate following penetrating head trauma or craniotomy, which, of course, is usually known in the clinical setting. The transitional zone between the 2 components is almost smooth; fluid-fluid levels cannot be recognized unambiguously. Simplified schematic drawing of the development of cSDHs via SDHys/SDHHys according to Hymel et al,20 Hedlund,22 Wittschieber et al,27 Zouros et al,29Lee et al,34 and Lee.49 The findings within the yellow box demonstrate the possible SDC entities following AHT that can often be found during initial cross-sectional neuroimaging. MRI studies have shown that almost half of all newâborns have perinatal subdural blood, generally referred to as subdural haematoma (SDH) or perinatal SDH. She was managed by subdural tap, bilateral craniotomy, broad-spectrum antibiotics, and subduroperitoneal shunt insertion. However, these differential diagnoses usually cannot explain the symptomatology of AHT as a whole. It has been proposed that subdural hygromas, at least sometimes, represent prominent subdural effusions in which there is a separation of the dural border cell layer with an accumulation of fluid 7. Subdurale hygroom kan worden gevormd in elke leeftijd periode. To this end, the different subdural collection entities are presented and illustrated. Subdural hygromas are encountered in all age-groups but are overall most common in the elderly 7. Several distinguishing criteria have been proposed (Table 3) to address this question.22,27⇓–29,33,66,74 The most important criterion is the presence of subdural neomembranes, septa, or chamber-like formations characterizing cSDHs. In light of serious physical, psychological, and legal consequences, physical child abuse attracts increasing attention in terms of health policy and health economy.1⇓–3 Head injuries represent the most frequent cause of lethal outcome and mainly relate to children within their first and second years of life.4⇓–6 Currently, the term “abusive head trauma” (AHT) is used for any nonaccidental or inflicted head injuries in pediatrics.7⇓–9, AHT has a worldwide incidence of 14–30/100,000 live births among children younger than 1 year of age.5,10⇓⇓–13 Additionally, a high amount of underreporting has to be assumed because many cases are not identified due to subclinical courses, nonspecific symptoms, or missing medical consultation.14 Meta-analyses on the outcome revealed an average mortality rate of around 20% among children younger than 2 years of age.15 Survivors showed severe disability (eg, tetraplegia, epilepsy, or blindness) in ∼34%, and moderate disability (eg, hemiplegia, memory and attention difficulties) in ∼25% of the cases.15. 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