Subdural Hygroma Symptoms And Treatment Overview

Subdural Hygroma Definition:- A Subdural Hygroma is a collection of cerebrospinal fluid, without blood (while not blood), located under the dural membrane of the brain. There are the most subdural hygroma are believed to be derived from the chronic subdural hematomas. Therefore, they’re ordinarily seen in elderly people after minor trauma but can also be seen in children following infection or trauma. Furthermore, one of the common causes of subdural hygroma is a sudden decrease in pressure as a result of placing a ventricular shunt. Therefore, it may lead to leakage of cerebrospinal fluid (CSF) into the subdural space (SDS) particularly in cases with moderate to severe brain atrophy. Therefore, in these cases the symptoms like mild fever, headache, drowsiness, and confusion can be seen, which are relieved by draining this subdural fluid.

Therefore, subdural hygroma is an collection of the cerebrospinal fluid in subdural space which may occur secondary to the surgery and trauma, or for iatrogenic reasons, such as the lumbar puncture. Therefore, lumbar puncture is the procedure that used normally for intrathecal chemotherapy for patients with B-cell acute lymphocytic leukemia (B-ALL) though the subdural hygroma is very rare complication. Furthermore, we present a case of a fatal, refractory subdural hygroma in a patient with B-ALL.

Note: A subdural hygroma (SDG) refers to the accumulation of fluid in the subdural space. In several cases, it’s considered an epiphenomenon of head injury when it is known as a traumatic subdural hygroma.

Subdural Hygroma Symptoms and Signs

Most subdural hygromas are clinically insignificant and small. The majority of the patient with SDG will not experience symptoms. Therefore, few commonly reported, but nonspecific, the symptoms of SDG that have been reported include nausea and headache. seizures and focal neurologic deficits have also been reported but are nonspecific to SDG. Furthermore, larger hygromas can cause secondary localized mass effects on the adjacent brain parenchyma, and enough to cause a neurologic deficit or other symptoms. Therefore, acute subdural hygromas may be a potential neurosurgical emergency, requiring decompression and therefore, Acute hygromas are typically a result of head trauma—they are a relatively common posttraumatic lesion—but therefore, it may also develop the following neurosurgical procedures, and have additionally been associated with the variety of conditions, with dehydration in the elderly, connective tissue diseases and lymphoma.

Clinical Presentation

The vast majority of patients are asymptomatic. However, some symptoms uncommonly reported include:

changes in mental status
focal neurological deficits
nausea and vomiting
headaches
seizures

Epidemiology

A subdural hygroma (SDG) is encountered in mostly in every age-groups but overall most common in the elderly. The demographics will depend on the underlying cause that includes:

spontaneous intracranial hypotension
idiopathic: in pediatric patients
post-surgical, e.g. hematoma evacuation, ventricular drainage
trauma

Pathology

The pathogenic of subdural hygromas isn’t entirely understood. In a general way countered explanation is a tear in the arachnoid layer forming a ball-valve opening allowing CSF one method passage into the subdural space. Therefore, although this explanation has the advantages of simplicity, it does not inevitably represent a true description of the underlying mechanisms. furthermore, it has been proposed that subdural hygromas, rare infrequently, represent popular subdural effusions in which there is a decomposition of the dural border cell layer with an accumulation of fluid. There is naturally a connection between the subdural hygromas and chronic subdural hematomas and acute on chronic.

Radiographic Features

In radiographic features, the subdural hygromas occur on the supratentorial cerebral convexities, and therefore, incidence within the posterior fossa is rare

CT/MRI

A subdural hygroma radiographically seems as a crescentic near-CSF density/signal accumulation within the subdural space that doesn’t extend into the sulci and infrequently exerts significant mass-effect. furthermore, vessels rarely cross through the lesion in contrast-enhanced studies. significantly these collections don’t entirely follow CSF on FLAIR, usually appearing hyperintense.

Etiology and Pathophysiology

Subdural hygromas need two conditions in order to occur. Therefore, first, there should be a separation in the cell layers of the dural membrane of the brain. and furthermore, the second, the resulting subdural space which may occur from the separation of layers should remain uncompressed in order for CSF to accumulate in the subdural space resulting in the hygroma.

Therefore, subdural hygromas occur when events like, infections, head trauma, or cranial surgeries happen in tandem with brain atrophy, prolonged spinal drainage, severe dehydration, or any other event that causes a decrease in intracranial pressure. Furthermore, this provides the basis for why subdural hygromas more commonly occur in infants and elderly, and infants have compressible brains while elderly patients have a greater amount of space for fluid to accumulate because of brain atrophy from age.

What is The Important Role of Subdural Hygroma in The Pathogenesis of Subdural Hematoma?

There are some chronic subdural hematomas that may be derived from the subdural hygroma brain atrophy or loss of brain tissue because of any cause, like alcoholism, or stroke, can provide either an increased space between the dura and the brain surface where a subdural hygroma can form (you can see in the image below) or traction on bridging veins which span the gap between the cortical surface and dura or venous sinuses.

Note:- Atrophy of the brain, resulting in the space b/w the brain surface and therefore, the skull increases the risk of subdural hematoma.

Subdural Hygroma Treatment

Most subdural hygromas that are asymptomatic do not need any treatment. furthermore, some might opt to perform an easy burr-holes to alleviate intracranial pressure (ICP). sometimes a temporary drain is placed for 24-48 hours post-op. In continual cases, a craniotomy could also be performed to try to locate the location of the CSF Leak. Therefore, in certain cases, a shunt is placed for extra drainage. A great warning is used when the choosing to look for the CSF leak due to them usually being troublesome to identify.

REFERENCES

1. Subdural Hygroma From Wikipedia https://en.wikipedia.org/wiki/Subdural_hygroma
2. Article taken from the Radiopaedia references
3. Dynamics of subdural hygroma following decompressive craniectomy: a comparative study
4. Article taken from the Reference Medscape
5. averas, Juan M. et al., eds. Radiology: Diagnosis, Imaging, Intervention. 1994- ISBN 0-397-57115-1; ch. 37: 9-13.
6. LEE, K. S. (1998-01-01). “The pathogenesis and clinical significance of traumatic subdural hygroma”

DISCLAIMER: These materials are for academic professional educational purposes only and aren’t a source of medical decision,- making advice. To consult a knowledgeable medical consultation, before taking the medical decision.