Diabetic ketoacidosis (DKA) induced cerebral edema complicating small chronic subdural hematoma/hygroma/ at Zewuditu memorial hospital: a case report

Background While both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors’ best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma. Case summary This study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA’s medical treatment. Conclusion DKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.

Postoperative spinal subdural hygroma without incidental durotomy: illustrative cases

BACKGROUND Spinal subdural hygroma (SSH) is a rare pathological entity occurring as a complication of spinal surgery. It is different from spinal subdural hematoma due to blunt trauma, anticoagulation therapy, spinal puncture, and rupture of vascular malformations. OBSERVATIONS The authors presented five patients with SSH who received decompression for lumbar stenosis. None had incidental durotomy. All presented postoperatively with unexpectedly severe symptoms, including back and leg pain and weakness. Postoperative magnetic resonance imaging (MRI) revealed SSH with a characteristic imaging finding termed the “flying bat” sign. Four patients underwent evacuation of SSH, with immediate and complete resolution of symptoms in three patients and improvement in one patient. One patient improved without additional surgery. At surgery, subdural collections were found to be xanthochromic fluid in three patients and plain cerebrospinal fluid (CSF) in one patient. LESSONS Unexpectedly severe back and leg pain and weakness after lumbar or thoracic spine surgery should raise suspicion of SSH. MRI and/or computed tomography myelography shows the characteristic findings termed the flying bat sign. Surgical evacuation is successful although spontaneous resolution can also occur. The authors hypothesized that SSH is due to CSF entering the subdural space from the subarachnoid space via a one-way valve effect.

Diabetic Ketoacidosis (DKA) Induced Cerebral Edema Complicating Small Chronic Subdural Hematoma/Hygroma/ at Zewuditu Memorial Hospital: A Case Report

BackgroundWhile both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors’ best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma.Case summaryThis study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA’s medical treatment.ConclusionDKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.

Ruptured middle cranial fossa arachnoid cysts after minor trauma in adolescent boys presenting with subdural hygroma: two case reports

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. Case summary 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.

Subdural Hygroma- A Case Report

Introduction: An accumulation of Cerebrospinal fluid in subdural spaces is known as subdural hygroma. It is encountered in all age-groups but overall, most common in elderly. The exact pathogenesis of Subdural Hygroma is still unclear. Presentation of Case: A 03 months old female child was brought to Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India on date 02/10/2020 with the complaints of breathing difficulty, elevated body temperature, excessive enlargement of head with bulged and tense fontanel, high pitch shrill cry, restlessness, nausea and vomiting. On physical examination, it is found that head circumference was 44 cm, head size was enlarged, bulged anterior fontanel, angular cheilitis, pale conjunctiva as well as peripheral cyanosis were present. The child was diagnosed at birth and child was brought to Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha for surgical management of subdural hygroma. Intervention: The treatment of patients was started immediately after admission.Burr-Hole Evacuation was done on 4th October 2020 and the patient was discharged on 08th October 2020. Conclusion: In this report, we mainly focus on expert surgical management and excellent nursing care helped in managing the complicated case very nicely. The patient response was positive to conservative and nursing management. The patient was discharged without postoperative complications and satisfactory with recovery.

Chronic Subdural Hygroma in Battered Baby.

The battered baby syndrome is a condition in which a child is seriously physically abused by thecaregiver or parents. The World Health Organization (WHO) estimates 40 million children aresubjected to abuse and neglect around the world. Most of the industrialized countries have theirreporting and surveillance system and data on child battery but in developing countries includingIndia, there is a lack of data regarding the extent of child battering that takes place within thehouseholds or institutions. India published a report on one of the largest surveys done on childabuse and found that two out of every three children were physically abused and 88.6% of themsuffered at the hands of their parents. Unfortunately, the methodology restricted the study to onlyolder children who could give a history of abuse. Therefore, the magnitude of the problem given onlyhighlights among children above the age of 5 years. [1]. we are reporting a case of an Infant withFebrile encephalopathy, detailed examination and investigation found out a case of chronic SubduralHygroma with classical neuroimaging features of Abusive trauma. We have done a multidisciplinaryapproach with a Neurosurgeon, a social worker who treated the child with burr hole surgery forsubdural hygroma & the child recovered with consciousness. This case is Special because a 5-monthMale infant was subjected to abuse due to a psychological problem in a Family Member, suspicionwas lacking as males are unlikely to undergo gender-biased in India and Early age of presentation.