AN UNUSUAL CASE OF SUBDURAL HAEMATOMA Theuns van Jaarsveld 28 January 2009.
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Transcript of AN UNUSUAL CASE OF SUBDURAL HAEMATOMA Theuns van Jaarsveld 28 January 2009.
AN UNUSUAL CASE OF SUBDURAL HAEMATOMA
Theuns van Jaarsveld
28 January 2009
CASE REPORT
• A 21 yr old male attended the emergency department after “sustaining” a head injury the previous day
• He was playing football and had headed the ball several times in a row
• After this he started to develop a headache but was able to finish the football game
• The following day he still had the headache and went to his local emergency department
• No loss of conciousness was reported after the incident or any other neurological symptoms
ON EXAMINATION
• He was alert and fully orientated
• Pupils equal and reactive to light
• No focal neurology found in limbs
He was given advice on concussion and analgesia and discharged
• He re-attended the emergency department 2 weeks later complaining of persistent headaches
• Again no focal neurology was found and he was given further advice on analgesia and discharged
• 3 weeks after the initial injury he re-attended complaining of headaches
• He had vomited 1 time during the previous day and had transient episodes of blurred vision
• In view of the persistent symptoms, despite the triviality of the original injury, a CT scan of the head was done
CT SCAN
•
CT SCAN
• Bilateral chronic subdural haematomata
• Mild frontal oedema
• Left middle cranial fossa arachnoid cyst
The case was discussed with neurosurgery and a MRI scan was done of the head
MRI SCAN
• He was reviewed at the neurosurgery OPD and it was decided to drain the cyst surgically
• He made an uneventfull recovery
DISCUSSION
• Intracranial arachnoid cysts account for about 1% of IC space occupying lesions
• They are non-tumorous congenital sacs lined with an arachnoid-like membrane and filled with CSF like fluid
• Pathologically they can increase in size, remain the same or completely resolve
SUGGESTED EXPLANATION FOR INCREASE IN SIZE
• Unidirectional flow through a ball-valve opening in the wall with trapping of CSF in the cyst
• Active secretions of fluid by cells lining the cyst wall
• Most common site is the middle cranial fossa
SIGNS AND SYMPTOMS
• Compression on surrounding tissues by the cyst
• Most common Sx and Sx – Increased
ICP
- Craniomegaly
- developmental
delay
• CHILDREN - craniomegaly
- seizures
- psychomotor retardation
• ADULTS - headaches
- seizures
- focal neurological deficits
COMPLICATIONS
• Acute increase in cyst size• Subdural effusion after rupture• Subdural or intra-cyst bleeding• DIAGNOSES - CT or MRI• PROGNOSIS- untreated arachnoid cysts may
cause permanent neurological damage because of progressive expansion or haemorrhage but with trratment most individuals do very well
• Pasients who re-attend after minor head injuries represent a high risk group of pasients in whom a CT scan usually yield a positive scan in 14 % of cases
• CT scans in these pasients may pick up previously asymptomatic neurological conditions such as aneurysms, abcesses or tumours or unexpected pathology such as a chronic subdural