Traumatic subdural hygroma: five cases with changed density and spontaneous resolution

Abstract

-Thirty-four consecutive adult patients with subdural traumatic hygroma were analysed for clinical evolution, serial computed tomography scan (CT), and magnetic resonance imaging (MRI) over a period of several months. Five of the patients presented CT scan and MRI evolution data showing increasing density over a period of 11 days to 6 months post trauma. In these five patients, final clinical and CT scan data were benign, with complete spontaneous resolution. Descriptions in literature of evolving traumatic subdural hygroma have presented CT scan density modifications changing into chronic subdural hematoma. Our patients show another possibility, density transformation, which sometimes show as subdural hematoma in CT scan and MRI, but with final evolution where clinical condition and CT scan return to normal.KEY WORDS: traumatic subdural hygroma, evolution, head injury, CT scan .Higroma subdural traumático: a propósito de cinco casos com modificação de densidade e resolução espontânea RESUMO -Analisamos 34 pacientes adultos com higroma subdural traumático quanto à evolução clínica, tomografias seriadas e ressonância magnética. Observou-se aumento da densidade do higroma subdural em cinco dos pacientes durante período que variou de 11 dias a 6 meses após o trauma. Nestes cinco pacientes, a evolução clínica foi favorável e os higromas apresentaram resolução espontânea. Há vários relatos na literatura de modificação da densidade dos higromas subdurais tramáticos, transformando-se em hematoma subdural crônico. Esta casuística apresenta outra possibilidade, ou seja, modificação da densidade, que pode ser apresentada como hematoma subdural pelas imagens de tomografia ou ressonância magnética, mas com resultado final das condições clínicas e de imagem retornando ao normal. PALAVRAS-CHAVE: higroma subdural traumático, traumatismo crânio-encefálico, evolução, tomografia computadorizada.Post-traumatic subdural hygroma is common, but its natural history is not well defined because there are few reports of clinical and computed tomography scan (CT) evolution data. These reports lack a uniform approach to method and segment time [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Some authors have reported traumatic subdural hygroma presenting density modifications in the CT scan with change to chronic subdural hematoma 4,7,9,10,12,13,[15][16][17][18] . This study reports a series of South American adult patients with traumatic subdural hygroma, with emphasis on the evolution of clinical and CT scan data. METHODThirty-four 34 consecutive adult patients with subdural traumatic hygroma were analyzed; they were analyzed with emphasis on patients who presented density modifications over a follow-up time segment. Each patient was studied for clinical evolution, serial CT scan and magnetic resonance imaging (MRI) data for several months.This study was approved by our University Hospital Ethics Committee for Human Research. RESULTSThere were 34 patients, with ages ranging from 16 to 85 years (mean 40), se...

Normal pressure subdural hygroma with mass effect as a complication of decompressive craniectomy

“…92% of patients who have undergone DC harbor the TSH ipsilateral to the surgery side. [1019232427] High dynamic accidents and diffuse traumatic brain injuries have been pointed out as risk factors for a subdural hygroma (SDG) following DC. [6–8101216182325] On the other hand, duraplasty at the time of DC has been observed to lower the incidence of TSH.…”

“…proposed a new classification of TSH according to the presence of mass effect and hydrocephalus. [2627] They divided TSH into group I without mass effect, and II with mass effect. A subdivision was made in group I into Ia without hydrocephalus, and Ib with hydrocephalus.…”

Subdural Hygroma: Different Treatment Modalities and Clinical Outcome

“…Whereas patients with mild and moderate GCS showed good recovery (19/22 patients, 86%) regardless of type of management they had (Table 4). Many authors reported similar results with a high percentage of good outcome in patients with mild and moderate Glasgow Coma Score [11] [21] [24]. Other factors as age, gender, site of SDHy or associated pathology had not yet reached a statistical significant value in determining the clinical outcome or even the type of management of patients with subdural hygroma.…”

The comparison between surgical procedure and conservative treatment in the management of traumatic subdural effusion

“…Some investigators indicated that conservative methods is the appropriate one for its spontaneous resolution (5,8,19). Others suggested that surgical procedure is necessary for the complications of mass effect and it can relieve patients' suffering immediately (2,16).…”

“…Poor prognosis appears when mass effect, serious brain injury or intracranial hematoma occur, and the mortality is high (1,2,4). █ InTRODuCTIOn T raumatic subdural effusion is a common disease, and has a high percentage in traumatic head injury cases (2,4,7,12,19,20). Traumatic subdural effusion occurs AIm: Traumatic subdural effusion (TSE) occurs following traumatic brain injury and may be treated by either conservative methods or surgical procedure commonly according to the patients' clinical information.…”