Subdural hygroma with membranes

Case contributed by Dr Joseph Scheller

Presentation

Infant with macrocephaly

Patient Data

Age: 7 months
Gender: Male

Bilateral symmetric large subdural fluid collections. Mildly increased left subarachnoid space.

MRI

Mixed attenuation subdural collections bilaterally, Subdural membranes. Thrombosed cortical veins.

Case Discussion

Gradually increasing head circumference in the first several months of life. There was no record of head trauma at birth or in infancy. Infant referred to a neurosurgeon for macrocephaly.  Imaging revealed large subdural collections. Subdural tap elicited 30cc of bloody fluid. Skeletal survey and neck MRI were normal. A diagnosis of abusive head trauma was considered and then reconsidered. The child was discharged and has had normal development with resolution of the collection at age 18 months.

The differential here is between a subdural hygroma and chronic subdural hematoma.  Chronic subdural hematomas in an infant would not be expected to be this large and symmetric, and they would have the consistency of motor oil when drained. Subdural hygromas could be large and symmetric, and might intermittently bleed due to stress on small bridging blood vessels and the vascularity of the newly created membrane 1.

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Case information

rID: 83160
Published: 17th Nov 2020
Last edited: 17th Nov 2020
Inclusion in quiz mode: Included