Peritoneal cerebrospinal fluid pseudocysts: a complication of ventriculoperitoneal shunts

The authors report seven cases of peritoneal pseudocysts in children with ventriculoperitoneal shunts. After describing the etiopathogenetic hypotheses, the symptomatology and the diagnostic investigations, they review the various types of treatment adopted to date and propose a simple and effective method, which has resulted in rapid resolution of all seven cases.     

Chronic subdural hematoma presenting as ataxic hemiparesis

A 57-year-old man was admitted for a typical left ataxic hemiparesis syndrome. He presented no vascular risk factor, with normal blood pressure. CT scan showed a frontoparietal right subdural hematoma. After surgery, the symptomatology disappeared completely. This observation reveals that subdural hematoma must be considered as a possible etiology of ataxic hemiparesis syndrome. The physiopathology is discussed.     

Chorea: a late complication of a subdural hematoma

Subdural hematoma has rarely been implicated as a cause of chorea. We describe a case of chorea occurring several months after evacuation of a traumatic subdural hematoma. No other causes of chorea were found. In this case and one previously reported case, signs of tentorial herniation were present prior to surgery. Herniation may damage the basal ganglia, with resultant chorea.     

Chronic subdural hematoma presenting as transient neurologic deficits

Four patients with symptoms of transient neurological dysfunction were subsequently found to have chronic subdural hematomas (CSDH). The frequency of these episodes diminished significantly after evacuation of the hematoma. The effects of vascular compromise due to the CSDH and to cardiovascular events, more commonly implicated in transient ischemic attacks (TIAs) may be additive. The inclusion of a computerized axial tomographic (CAT) scan in the evaluation of some patients with presumed TIAs is recommended.     

Retrograde migration of the abdominal catheter as a complication of ventriculoperitoneal shunts: the fishhook sign

Three cases of retrograde migration of the distal catheter of ventriculoperitoneal shunts into the subcutaneous fibrous tract of the thoracic wall are reported. To the authors' knowledge this is the first time that this complication of ventriculoperitoneal shunts has been described.     

慢性硬脑膜下血肿与癫痫

以癫痫为首发症状的慢性硬脑膜下血肿１２例，男９例，女３例。大发作３例，局灶性发作９例。对以癫痫为首发的临床症状、体征、脑电图、ＣＴ等资料作了分析；对慢性硬脑膜下血肿所致癫痫发作的病因、血肿包膜的病理生理及临床处理作了讨论，认为早期手术术后继服用抗癫痫药物治疗效果良好。     

Chronic subdural hematoma in utero

A case of chronic subdural hematoma and hydrocephalus diagnosed in utero is presented. No history of trauma could be elicited. Laboratory investigations failed to show a coagulation disorder. Both the hematoma and hydrocephalus were surgically treated 8 days after delivery. At 14 months of age the child is showing moderately delayed development. The literature is reviewed and discussed. The importance of correct antenatal diagnosis is stressed.     

Chronic subdural hematoma preceded by traumatic subdural hygroma

Patients with traumatic subdural hygroma (SDG) are at an increased risk of developing chronic subdural hematoma (CSDH). However, the mechanism by which this occurs is still not fully understood. The purpose of this paper is to investigate the clinical characteristics and pathogenesis of CSDH, as well as the relationship between CSDH and SDG. We review the pertinent literature and retrospectively examine a series of cases in which CSDH had been preceded by SDG to understand the natural history and developmental mechanisms of these lesions. We discuss the cases of 24 patients in whom CSDH developed from traumatic SDG between 2001 and 2005. Headache was the most common symptom, and the mean Glasgow Coma Scale score was 14.1. Increases in SDG volume were observed in CT scans of 17 patients, and increased density and volume was observed in five patients. The mean interval between the two diseases was 57.6 days, and 13 patients developed new symptoms after the development of CSDH. The most common symptoms at that time were headache and hemiparesis. All patients underwent an operation, which resulted in good recovery in all but one case. The cycle of persistent SDG, rebleeding, coagulation and fibrinolysis contributes to the development of CSDH from SDG. It is important to understand the natural history of CSDH and carefully follow up patients with head injury, especially if it is associated with SDG, and the potential for the development of CSDH should be considered.     

Cerebral fluid edema: an unusual complication of ventriculoperitoneal shunts

Introduction A case of accumulation of CSF into the brain parenchyma simulating a brain tumor, secondary to an obstructed ventriculoperitoneal shunt, is presented. Until now, only seven cases of this rare complication have been described.Case report Magnetic resonance showed an expansive, low-density intracranial lesion on the right frontal and parietal lobe. This mass was biopsied, but no tumor was found and the diagnosis was brain edema.Conclusion The mistake in the diagnosis was due to the clinical symptoms and to the MR images.     

Cysticercosis presenting as a subdural hematoma

We describe a patient with a history of cerebral cysticercosis who presented with signs and symptoms of increased intracranial pressure; CT showed what seemed to be a subdural hematoma. At operation, the "hematoma" proved to be a subdural collection of multiple cysticercal cysts. This is the first report of this complication.     

Chronic subdural hematoma in capoeira sport

Chronic subdural hematomas in young people is extremely rare and has some provoking factors such as V-P shunts, arachnoid cyst, anticoagulant drug usage, vigorous sports and coagulopathies. A static or dynamic mechanical load is almost always delivered to skull associated with either mild or severe head trauma. A 25-year old-man who was previously healthy has complained of intermittent headache for six months. He had been interested in capoiera (Brazilian exciting sport) for two years and has had no any evidence of head injury. After admission, he was operated immediately because of chronic subdural hematoma. We report a patient who is the first chronic subdural hematoma in the literature due to playing capoeira.     

Chronic subdural hematoma in extremely aged patients

445 cases of chronic subdural hematomas have been operated on during the last 35 years (1951-1986). The ages of the patients ranged from 14 to 91 years and averaged 54 years. Two groups of patients were considered and compared: (A) extremely aged patients, who were over 75 years old, and (B) patients in their sixth decade of life whose age was in fact close to the mean age of chronic subdural hematoma patients in our experience. There were 35 cases (8% of the total number of cases) in group A and 113 cases (26%) in group B. Presumably etiological trauma was less severe in elderly patients who more frequently showed a background of hormonal derangement, such as liver and/or prostatic disease. Bilateral hematomas were detected more frequently in older patients. They usually presented with mental retardation, unlike younger patients who more frequently had symptoms and signs of increased intracranial pressure. Early postoperative complications occurred more frequently in older patients. However, this did not preclude obtaining good results in more than three quarters of them. The implications of these findings are discussed.     

Chronic subdural hematoma and transient neurologic deficits

Three cases of chronic subdural hematoma (CSDH) revealed by transient neurological accidents are reported. Although well-known this condition is rare: 1 to 9 p. 100 of CSDHs. Questioning may bring out a history of cranial injury and headache, even minor ones, which are unusual in transient ischemic accidents (TIA). Transient phenomena, such as motor aphasia or speech interruption, point to the diagnosis, especially in male patients over 60 years of age. The finding at electroencephalography of a delta activity more than 48 hours after a TND should exclude the diagnosis of TIA until a CT scan is performed. Since the causes of neurological deficits regressing within less than 24 hours may be ischemia as well a hemorrhage or tumour, the term of transient neurological accident (TNA) should preferably be used, and an emergency CT scan should be performed for diagnostic and therapeutic purposes. Owing to the possibility of another concomitant cause of TNA, the finding of a subdural haematoma should not deter from pursuing cardiovascular examinations. The mechanism of TNA probably involves a vascular factor, as suggested by I-123 IMP cerebral SPECT which shows an intercritical decrease in cerebral blood flow and/or an epileptic factor.     

Chronic subdural hematoma after transsphenoidal surgery.

Chronic subdural haematoma has not been reported as a complication of transsphenoidal surgery. We present a case of pituitary adenoma which was gross-totally removed by transsphenoidal surgery with the enlarged sellar opening. Postoperative serial imaging showed massive air accumulation in both frontal subdural spaces followed by subdural fluid collection and subsequent chronic subdural haematomas 2 months later. We conclude that close follow up imaging study is required to avoid overlooking chronic subdural haematoma when massive air is introduced into the subdural space by the transsphenoidal surgery.     

Torticollis as a late complication of ventriculoperitoneal shunt surgery

The pathophysiological mechanisms related to aging of the material of a ventriculoperitoneal (VP) shunt and how mechanical stresses and mechanical traction applied to the VP shunt catheter contributed to the development of torticollis are discussed. We report a 14-year-old boy with torticollis developing as a late complication 12 years after placement of a left VP shunt for the treatment of aqueductal stenosis. The shunt tube and the surrounding fibrocalcified band were removed, and the patient’s torticollis resolved completely without recurrence. Biomechanical dysfunction of shunt material with resultant tethering at the most mobile part of the shunt tubing (neck) in a growing child can lead to the development of torticollis. To our knowledge this is the first report of this VP shunt complication.