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.

Menke's disease presenting with subdural fluid collection and fractures mimicking non-accidental injury

Menkes disease is a rare X-linked disorder resulting from a defect in the copper metabolism. Clinical features include seizure, developmental delay and hair changes. Fracture with callus formation is not uncommon in Menkes disease. Diagnosis is often difficult to establish early in childhood. To report a case of Menkes disease who had subdural effusion and radiological evidence of previous fracture niimicking non-accidental injury. A male infant born to consanguineous parents. He developed intractable seizures at 6 weeks. Clinical examination revealed macrocephaly, gray iris, absent eyebrows, divergent squint, sparse, thin. hypo pigmented, and kinky hair. MRI brain showed massive bilateral subdural fluid collection. Skeletal survey revealed perosteal reaction and callus formation with evidence of old fracture of the left and right humerus. Family and social history disputed child abuse. Serum copper and cerloplasmin were persistently low. Menkes disease maybe difficult to differentiate from Non-accidental injury especially when subdural effusion and fractures are present. High index of suspicion is needed to out rule Menlces disease

The fate of traumatic subdural hygroma in serial computed tomographic scans

We reviewed serial computed tomographic (CT) scans of 58 patients with traumatic subdural hygroma (SDG) to investigate its natural history. All were re-evaluated with a special reference to the size and density of SDG. Thirty-four patients (58.6%) were managed conservatively and 24 patients (41.4%) underwent surgery. The lesion was described as remained, reduced, resolved, enlarged and changed. Means of interval from injury to diagnosis and any changes in CT were calculated. SDGs were resolved in 12 (20.7%), reduced in 15 (25.9%), remained in 10 (17.2%), enlarged in 2 (3.4%), and changed into chronic subdural hematoma (CSDH) in 19 patients (32.8%). SDG was diagnosed at 11.6 days after the injury. It was enlarged at 25.5 days, remained at 46.0 days, reduced at 59.3 days, resolved at 107.5 days, and changed into CSDH at 101.5 days in average. SDGs were developed as delayed lesions, and changed sequentially. They enlarged for a while, then reduced in size. The final path of a SDG was either resolution or CSDH formation. Nearly half of SDGs was resolved or reduced within three months, however, 61.3% of unresolved or unreduced SDG became iso- or hyperdense CSDH. These results suggest that the unresolved SDG is the precursor of CSDH.