Post meningitis subdural hygroma: Anatomical and functional evaluation with ^99m Tc-ehylene cysteine dimer single photon emission tomography/computed tomography

Abstract

Subdural hygroma is the collection of cerebrospinal fluid in the subdural space. Most often these resolve spontaneously. However, in cases with neurological complications surgical drainage may be needed. We here, present the case of an 8-year-old boy with post meningitis subdural hygroma. 99mTc-ehylene cysteine dimer (99mTc-ECD) hybrid single photon emission tomography/computed tomography (SPECT/CT) carried out in this patient, demonstrated the subdural hygroma as well as the associated cerebral hypoperfusion. If 99mTc-ECD SPECT/CT is integrated into management of these patients, it can help in decision making with respect to conservative versus surgical management.

Symptomatic Subdural Hygroma Following Acinetobacter Meningitis in an Infant

“…Subdural hygroma, also named “fluid collection” or “effusion” by various authors [ 1 , 5 , 6 ], is defined as an accumulation of CSF in the subdural space and may be secondary to ventricular shunting (the most common cause), brain injury, meningitis, or may be idiopathic, as a result of abnormal CSF absorption and rupture of the outer arachnoid membrane [ 1 , 2 ]. Postmeningitis subdural collection (a term that authors often wrongly use as a synonym of subdural empyema [ 7 ]) is a common complication of bacterial meningitis in infancy [ 8 ].…”

“…Imaging studies show an enlargement of the subdural space, which is filled with CSF [ 9 ]. Distinction from cerebral atrophy with cUS and CT alone is difficult but may be possible through contrast-enhanced MRI or perfusion single photon emission tomography (SPECT) [ 2 ].…”

“…The decision to adopt a conservative or surgical management is still controversial. Most subdural hygromas resolve spontaneously, thus the decision regarding the type of management is guided by clinical presentation and imaging findings [ 2 ], including the size of the lesion and its progression [ 5 , 6 ]. The most common indications for surgery are persistent or recurrent fever, seizures, and bulging fontanelle [ 7 ].…”

“…Subdural hygromas typically arise as a consequence of ventricular shunting; however, they can also manifest as a complication of bacterial meningitis [ 1 , 2 ]. In young infants, bacterial meningitis is predominantly caused by group B Streptococcus (GBS) and Gram-negative species [ 3 ].…”

MRI Spectrum of Haemophilus influenzae Meningoencephalitis in Children

“…The definite cause of subdural hygroma is unknown but is believed to be secondary to arachnoid membrane rupture with CSF trapping in the subdural space. [ 19 ] One patient presented with imaging and clinical features of probable acute disseminated encephalomyelitis (ADEM) secondary to Hib infection. This patient presented with fever and vomiting for 3 days and one episode of generalized tonic-clonic seizures followed by altered sensorium.…”