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Subdural hygroma


The subdural hygroma is the delimited accumulation of cerebrospinal liquid which resulted from ChMT in a subdural space, a defiant prelum of a brain.

Reasons of a subdural hygroma:

The subdural hygroma is formed at ChMT of various weight owing to a rupture of subarachnoidal tanks, is more often on the basis of a brain (suprasellyarny, side, etc.) from where TsSZh extends konveksitalno. The volume of a subdural hygroma fluctuates from 30 to 250 ml; their contents represent bloody, xanthochromatic or colourless liquid which on the biochemical indicators is much closer to TsSZh, than to blood serum.

Symptoms of a subdural hygroma:

Subdural hygromas can develop as isolated, and in a complex combination with brain bruises, intracranial hematomas, subarachnoidal hemorrhage, fractures of bones of a skull. These circumstances cause polymorphism of a clinical picture of a subdural hygroma. If the subdural hygroma dominates in a clinical picture, then its manifestation and a current remind those at intracranial hematomas, especially subdural. Three-staging of change of consciousness is characteristic of subdural hygromas in these cases. Primary loss of consciousness often happens short and does not reach coma degree. In a light interval (see. The light interval) is observed either a complete recovery of consciousness, or moderate devocalization. Several hours later or days on this background the headaches pristupoobrazno amplifying and having the shell shade are noted (local morbidity, irradiation in eyeballs, cervicooccipital area, a photophobia). Cephalalgia paroxysms from time to time are followed by vomiting. Comparative frequency of disturbances of mentality as the frontal syndrome (decrease in criticism to the state, euphoria, the apatiko-abulichesky phenomena, a disorientation together and time, mnestichesky frustration, confabulations, etc.) supplemented by emergence of hobotkovy and prehensile reflexes attracts attention. Quite often psychomotor excitement develops. In a clinical picture of subdural hygromas meningeal symptoms rank high. More often they are caused by irritation of a meninx both accumulation of TsSZh, and the accompanying subarachnoidal hemorrhage; have stem genesis with characteristic dissociation on a body axis less often (with dominance of a Kernig's sign over a stiff neck). The progressing bradycardia is typical for subdural hygromas. The initial phenomena of stagnation on an eyeground are often caught. These signs of a compression can precede or accompany secondary switching off of consciousness. Changes of a respiratory rhythm, a hyperthermia, neurologic trunk frustration are a little inherent to clinic of subdural hygromas.

Among focal symptomatology the leading role belongs to a gomolateralny mydriasis, a contralateral hemiparesis, and also (at an arrangement over a dominant hemisphere) to speech disturbances. The unilateral mydriasis at a subdural hygroma is usually expressed moderately and proceeds with preservation of its photoharmoses. If the hemiparesis is caused by the most subdural hygroma, then it quite often differs in softness and gradualness of development through a phase of brakhiofatsialny insufficiency. In clinic of a subdural hygroma the convulsive component is often shown; at the same time the clonic spasms which are originally arising in paretichny extremities can pass into the general epileptic seizure.

Like subdural hematomas, subdural hygromas are divided by rate of development of a prelum of a brain on acute, subacute, chronic. At an acute current of a subdural hygroma (with development of a compression of a brain in the first 3 days after an injury) there is their combination to other severe forms of ChMT more often. At a subacute current (with development of a prelum of a brain within 4-14 days after an injury) subdural hygromas usually act in rather "pure" look. Chronic subdural hygromas (with development of a prelum of a brain in terms from 2 weeks up to several years) differ from acute and subacute forms in formation of the capsule reminding on a structure a wall chronic subdural hematomas. At any form of a current of subdural hygromas their bilateral arrangement can meet, at the same time bilateral pyramidal insufficiency, quite often asymmetric due to the prevailing influence is found from a hygroma of bigger volume or the accompanying brain bruise.

Treatment of a subdural hygroma:

The subdural hygromas causing the general or local prelum of a brain are subject to surgical treatment. There is often enough imposing of a frezevy opening and puncture emptying of a subdural hygroma from which liquid is usually emitted with the pulsing stream. However it is necessary to consider that subdural hygromas can quickly recur owing to the remaining message of basal tanks with a konveksitalny subdural space. Therefore it is reasonable to drain a subdural space within 1-2 days. Use also endolumbar insufflations of air. Sometimes it is necessary to resort to aspiration of the accumulating liquid through the frezevy opening imposed at its primary emptying. At persistent subdural hygromas apply various options of the shunting operations. At a combination of subdural hygromas and intracranial hematomas, the crush centers when wide quick access is necessary, use osteoplastic trepanation.

Forecast. At the isolated subdural hygromas the forecast for life and a social and labor readaptation in the majority of observations favorable. At a persistent recurrence of subdural hygromas various complications and an invalidism of victims significantly increase. Lethal outcomes at subdural hygromas are usually caused by the accompanying heavy injuries of a brain and somatic burdenings.

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