Bilateral post-traumatic hygromas in patient with frontotemporal dementia

Abstract

Background: Frontotemporal dementia (FTD) is a highly disabling neurologic disorder characterized by behavioral alterations and movement disorders, involving patients with a mean age of 58 years. We present a unique case of a patient suffering from FTD who developed post traumatic bilateral hygromas. Case Description: A 52-year-old male patient, with an history of head trauma 3 months before, was admitted to our department for recurrent motor seizures. Anamnesis was positive for FTD with severe frontal syndrome. Brain computed tomography and magnetic resonance imaging (MRI) showed the typical “knife-blade” appearance of the cortical atrophy associated to bilateral hemispheric hygromas exerting mild mass effect. Brain MRI showed the signs of the cortical and “anti-cortical” vein. The two subdural collections were evacuated through two bilateral burr holes and controlled drainage. Despite anti-epileptic drugs therapy, in the early postoperative period, the patient presented further tonic-clonic seizures. The patient showed progressive recovery and was transferred to the neurorehabilitation center. After 6-month follow-up, he completely recovered. Conclusion: In FTD, severe cortical atrophy leads to space increase between arachnoid and pia mater that could affect the anatomical integrity especially after trauma, with possible development of hygromas. The coexistence of radiological findings of the cortical vein and sign of the “anti-cortical” vein can make difficult an exact differential diagnosis between a primitive hygroma and a Virchow hygroma from resorption of previous blood collection. Surgical treatment may be indicated in selected patients, but it is burdened by higher postoperative risks compared to the general population.

Acute disseminated encephalomyelitis and viral encephalitis: An unusual and misleading imaging

“…Hence it was not acute hemorrhagic leukoencephalitis (AHL). AHL, AHEM, and acute necrotizing hemorrhagic leukoencephalitis (ANHLE) of Weston Hurst are different variants of acute, rapidly progressive, and frequently fulminant inflammatory hemorrhagic demyelination of CNS white matter 8–14 . Death from brain edema is common within 1 week of onset of encephalopathy.…”

“…AHL, AHEM, and acute necrotizing hemorrhagic leukoencephalitis (ANHLE) of Weston Hurst are different variants of acute, rapidly progressive, and frequently fulminant inflammatory hemorrhagic demyelination of CNS white matter. [8][9][10][11][12][13][14] Death from brain edema is common within 1 week of onset of encephalopathy. There can be favorable outcomes with early and aggressive treatment with combination of corticosteroids, immunoglobulins, cyclophosphamide, and therapeutic plasma exchange.…”

Arachnoid Cyst Burst in Presence of Contralateral Nomura IV Subdural Hematoma: After Effects of Traumatic Kickback and Intracranial Pressure

“…In her remote history she reported two previous miscarriages, a left breast lump and surgical removal of two uterine polyps. The patient on admission has a GCS 15/15, multiple oscillations on the Romberg test and headache in the nuchal and vertex area [23][24][25][26][27][28][29][30].…”