Subdural effusion complicating neonatal meningitis: successful treatment with acetazolamide.

Postmeningitis subdural effusion is rare in neonates when compared to infants and children. For treatment, various modalities are described. Serial subdural punctures and surgical drain placement are advised for cases having a mass effect on imaging. We report a neonate with symptomatic postmeningitis subdural effusion, who failed to respond to serial subdural punctures, but subsequently managed successfully with acetazolamide. He had no recurrence further. His development was normal at 18 months of age.

Presentación inusual de los quistes aracnoideos / Unusual presentation of arachnoid cysts

Objetivo: Describir y analizar la asociación entre quistes aracnoideos e higroma subdural. Esta es considerada una complicación excepcional, con sólo 24 casos reportados en la literatura, siendo de 5 casos la serie publicada más numerosa. Método. Se realizó el análisis retrospectivo de las historias clínicas de 5 pacientes portadores de quiste aracnoideo, en los que la forma de presentación consistió en higroma subdural e hipertensión endocraniana. Resultados. El rango de edad fue entre 3 y 15 años (promedio: 7 años). La relación M/F fue 3/2. En 3 casos los síntomas se presentaron después de un traumatismo encefalocraneal leve y en los 2 restantes fue espontáneo. Todos se manifestaron con síntomas de hipertensión encefalocraneana y edema de papila bilateral, en 2 de ellos se constató paresia del VI par izquierdo. A todos se le realizó TAC y en 2 casos IRM. En los 5 pacientes se constató un higroma subdural con efecto de masa y quiste aracnoideo de fosa media. Se realizó tratamiento quirúrgico de urgencia en los 5 casos. Todos los pacientes evolucionaron favorablemente con desaparición del higroma subdural. Actualmente se encuentran asintomáticos con un exament neurológico y fondo de ojo normal. Conclusión. Si bien el higroma subdural con hipertensión endocraneana en una complicación poco usual, debe ser tenida en cuenta como una de las formas de presentación clínica de los quistes aracnoideos, la cual requiere inmediata resolución quirúrgica. Palabras clave: complicaciones, higroma subdural, hipertensión endocraneana, quiste aracnoideo.

Objective: To analize and describe the association between arachnoid cysts and subdural hygroma. This association is an unusual complication of which only 24 cases have been reported in the literature. Methods: The clinical records of 5 patients with arachnoid cysts presenting as a subdural hygroma with increased intracranial pressure were analyzed retrospectively. Results: The ages of the patients ranged between 3 and 15 years-old (mean: 7 years-old). M/F ratio was 3/2. Onset of symptoms was postraumatic in 3 and spontaneous in 2. All patients presented symptoms of increased intracranial pressure and bilateral papilledema, and in 2 out of 5 paresis of the VI cranial nerve was found. All children underwent CAT scan and MRI was performed in 2. In all patients, subdural hygroma with mass effect and arachnoid cyst of the middle fossa was found. Emergency surgery was carried out in all cases. Al patients evolved favorably with complete disappearance of the subdural hygroma. They are currently asynptomatic with normal neurological examination and fundoscopy. Conclusion: Even though subdural hygroma with increased intracranial pressure is an unusual complication, it should be known as one of the clinical presentations of arachnoid cysts, which required immediate surgical intervention. Keywords: arachnoid syst, complications, increased intracranial pressure, subdural hygroma.

Cerebral cysticercus granuloma associated with a subdural effusion.

The association of a solitary cerebral cysticercus granuloma with a subdural effusion is being reported. The granuloma and the effusion resolved following albendazole therapy. We speculate that the spread of the inflammatory changes around the granuloma to the subdural space could have led to the development of the subdural effusion.