31 : 445-450, 1992. Indicates open access to non-subscribers at www.ajnr.org. Classic SDH stages in CT and MRI (at 1.5T)a. The diversity of differential diagnoses shown in Table 2 illustrates that the diagnosis of a chronic process (cSDH) may be hasty. Subdurale hygroom kan worden gevormd in elke leeftijd periode. While the BV wall measures 50–200 μm within the subarachnoid space, the BV segments that penetrate the dura mater may have a wall thickness of only 10 μm and do not show additional external strengthening by connective tissue.45 Thus, increased vulnerability of dural BV portions is assumed.45 The resulting hemorrhage from the injured BVs fosters opening of the subdural space. I, Chronic SDH (MR imaging, T2WI, TSE, nonenhanced): a 4-month-old boy with numerous subdural septa and neomembranes. At least 5 possibilities of interpretation, besides SDHy and SDHHy, compose nearly all time-related SDH stages from hyperacute to chronic (Table 2, lower part).22 Hence, a reliable diagnosis and age estimation of the SDC are frequently not possible without additional MR imaging and serial neuroimaging, respectively. Lee KS. Hosten N, Liebig T. CT of the Head and Spine. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. In the context of AHT, subdural hematoma (SDH) is described as the most common intracranial pathology in infants and toddlers.20⇓–22 SDHs, like all SDCs, may occur unilaterally or bilaterally.23 The convexities of the cerebral hemispheres (Fig 1A), the falx cerebri, the tentorium cerebelli, and the middle and posterior cranial fossae are considered typical locations.22 In many cases, SDHs have a key role as a diagnostic marker only—that is, though they may represent an important symptom of child abuse, their volumes are often small, resulting in just a minor space-occupying effect.8,21,23⇓–25 Hence, frequently, SDHs do not have a prognostic relevance for the extent of brain damage.24 Depending on the developmental stage in which subdural blood is visualized by neuroimaging, SDHs have a wide variety of appearances (Table 1). Its formation commences at the innermost cell layer of the dura mater cleaved by the SDC. benign enlargement of the subarachnoid spaces in infancy, post surgical, e.g. However, such statements may be helpful if a “minimum age concept” is applied. Imaging differential considerations include: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Finally, in many cases, the question is whether the diagnosis is SDHy or cSDH. This can lead to leakage of CSF into the s… {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":18609,"mcqUrl":"https://radiopaedia.org/articles/subdural-hygroma/questions/1540?lang=us"}. CSF accumulation communicating freely with the subarachnoid space-SAS), or an effusion. Etiology: venous hemorrhage due to tear of bridging veins and or intradural venous plexus, anticoagulation Imaging: semilunar / crescent shape, crosses sutures, does not cross falx or tentorium — Hyperacute – inner layer of high density clotted blood + outer layer of low density nonclotted blood Benign external hydrocephalus (BEH), hygroma and chronic subdural haematoma are extra‐axial fluid collections in infants. De kans op het optreden neemt toe met de leeftijd en de atrofische veranderingen in de cerebrale weefsels. In neuropathology, the first formation of neomembranes is described as macroscopically visible after ∼10 days.74 Their radiologic detection may be challenging and often requires MR imaging, sometimes even supported by intravenous contrast. Subdural Hygroma Definition:- A Subdural Hygroma is a collection of cerebrospinal fluid, without blood (while not blood), located under the dural membrane of the brain. Subdural hygromas are subdural fluid collections of clear xanthochromic or blood-tinged fluid. -. A subdural hygroma (SDG) is a collection of cerebrospinal fluid (CSF), without blood, located under the dural membrane of the brain. In many cases of an SDC diagnosed as SDHy, it may be assumed that the SDC is actually the homogeneous variant of the SDHHy (Fig 1D) because the blood component may sometimes be relatively small and/or very “young” (hyperacute); furthermore, an intense mixture of blood and CSF may be present.27⇓–29 Hence, in our experience, SDHy and SDHHy are used interchangeably or synonymously in radiology reports. (2004) Brain injury. Acute, post-traumatic subdural hygromas, in contrast to benign chronic subdural hygromas, may be life-threatening. It has been proposed that subdural hygromas, at least sometimes, represent prominent subdural effusions in which there is a separation of the dural border cell layer with an accumulation of fluid 7. Note the different signal intensities and multiple fluid-fluid levels within subdural chamber formations, especially in the right occipital region. A portion of these cases develops further toward the findings shown within the blue box. 1. Ultimately, she had complete recovery without complications. J Pediatric Neuroscience 7(1): 33-55. No or only minimal injuries of the skin because skin bruises caused by firm grip at the arms or the thorax of the child are rare. However, these differential diagnoses usually cannot explain the symptomatology of AHT as a whole. hematoma evacuation, ventricular drainage 4. spontaneous intracranial hypotension Background: Subdural hygroma (SDHy) is a collection of cerebrospinal fluid (CSF) under the dural membrane. K.-S. Lee, “History of chronic subdural hematoma,” Korean Journal of Neurotrauma, v… Today, this view has changed. The term subdural hygroma (SDHy) is classically reserved for proteinaceous, clear, pink-tinged, or xanthochromatic collections within the subdural space containing pure CSF or at least CSF-like fluid; blood, blood products, or neomembranes are nonexistent by definition (Fig 1B, -C). CSDH is defined as a fluid collection within the layers of the dura mater. ... chronic extra-axial fluid collections in pediatric patients. 1998;12 (7): 595-603. Examination showed a young, fully conscious oriented boy with positive Cushing’s reflex and papilledema of left eye. Although this explanation has the benefit of simplicity, it does not necessarily represent a true description of the underlying mechanisms. Subdural collections with or without additional extra-axial findings such as subarachnoid hemorrhage, arachnoid tear, or bridging vein thrombosis. Two cases are presented in which a rapidly enlarging subdural hygroma either prevented improvement over a 1–2 week period or resulted in rapid deterioration of the patient. Objective: Hydrocephalus associated with subdural hygromas is a rare complication after decompression of Chiari malformation type I (CM-I). With respect to other variants of AHT, further features of head injury may occur, in particular, signs of blunt force (impact) trauma against the child's head such as skin lesions or skull fractures. Missing or inadequate anamnesis—that is, no trauma reported or report of just a minor trauma despite the presence of severe brain injury. Unable to process the form. However, it seems clear that an outer subdural neomembrane (at the dural side) is primarily formed. Vessels rarely cross through the lesion in contrast-enhanced studies (see cortical vein sign) 1. Subdural hematohygromas (SDHHys) are a combination of blood (or blood products) and CSF (or CSF-like fluid).22,28⇓–30 A homogeneous and a heterogeneous variant can be differentiated. Post-operative intra-spinal subdural collections after pediatric posterior fossa tumor resection: Incidence, imaging and clinical features Julie H Harreld , 1 Noryati Mohammed , 2 Grant Goldsberry , 3 Xingyu Li , 4 Yimei Li , 4 Frederick Boop , 5 and Zoltan Patay 1 Apart from the clinical and medicolegal significance for the diagnosis of child abuse, SDCs may also be relevant for criminological aspects because age estimation possibly facilitates further limitation of the circle of suspects. In addition, in-depth understanding of the pathogenesis of subdural hygromas is increasingly required by neuroradiologists, pediatricians, and forensic physicians. Enter multiple addresses on separate lines or separate them with commas. B, SDHy (nonenhanced CT): a 2-month-old boy with wide, homogeneously hypodense (or CSF-isodense) SDCs over both frontoparietal regions; no neomembranes or septa. Subdural Hygroma. Differential diagnostics of the various SDC entities is a challenging topic for the radiologist. These would also require a harmonization of methodology and terminology as a precondition. The pictographs schematically visualize the CT morphologic appearance of the respective SDC. There is undoubtedly a relationship between subdural hygromas and acute on chronic and chronic subdural hematomas 7,8.Â. A subdural hygroma is the accumulation of clear or xanthochromic CSF within the subdural space. Thus, an SDHy or SDHHy may develop additionally or subsequently (yellow box in Fig 2).27,29,49 The laceration of the arachnoid membrane may function as a valve preventing backflow of CSF.49,50 Besides this rapid mechanism, occurring within a few minutes or hours, delayed formations of SDHys and SDHHys, requiring up to several days, have been observed as well.27 Etiopathologically, there are 2 causative mechanisms: Influx of CSF or CSF-like fluid as a result of a posttraumatic, reactive, vasomotoric (diffusion) disorder within surrounding meningeal structures. The authors present a series of 5 pediatric patients who underwent CM-I decompression with placement of a dural graft complicated by posterior fossa hygromas and hydrocephalus that were successfully … However, some symptoms uncommonly reported include 5: The pathogenesis of subdural hygromas is not entirely understood. In initial CT investigations, SDCs frequently show a mixture of hyper- and hypodense proportions (so-called mixed-density pattern) (Fig 1E). Compared with CSF within the external and internal CSF spaces, the SDCs appear hypointense. In cases where mass-effect is radiographically demonstrated, it may be neurosurgically evacuated 5.Â. Subdural hematomas form between the dura and the arachnoid membranes Epidural hematomas arise in the potential space between the dura and the skull The pathophysiology, etiology, clinical features, and diagnostic evaluation of SDH will be discussed here. Subdural hygroma is a cerebrospinal fluid accumulation in the subdural space. Most subdural hygromas are believed to be derived from chronic subdural hematomas. Importantly these collections do not entirely follow CSF on FLAIR, often appearing hyperintense.Â, The vast majority of patients with subdural hygroma are asymptomatic without radiographic evidence of mass-effect, and thus neurosurgical intervention is rarely required 5. The radiologic investigation of SDCs has the potential to contribute to important issues such as type, number, and circumstances of the traumatic force or the age of injury. It is an epiphenomenon of head injury. De meest voorkomende lokalisatie van subdural hygroma - een boventijdelijk omgeving. The chronic SDH has a special position (see below: “Chronic Subdural Hematoma”). A common variant of the abusive head trauma is the shaken baby syndrome. Kertmen H, Gürer B, Yilmaz ER, Sekerci Z (2012) Chronic subdural hematoma associated with an arachnoid cyst in a juvenile taekwondo athlete: a case report and review of the literature: Pediatr Neurosurg 48(1): 55-58. The demographics will depend on the underlying cause which includes: 1. idiopathic: in pediatric patients 2. trauma 3. post surgical, e.g. The most commonly encountered explanation is a tear in the arachnoid layer forming a ball-valve opening allowing CSF one way passage into the subdural space. Subdural hygroma Subdural hygroma is a subdural fluid collection see Traumatic subdural hygroma. Subdural hematoma (SDH) forms when there is hemorrhage into the potential space between the dura and the arachnoid membranes. However, the large body of literature allows the differentiation of at least the following 6 entities. A subdural hygroma radiographically appears as a crescentic near-CSF density/signal accumulation in the subdural space that does not extend into the sulci and rarely exerts significant mass-effect 5. Subdural hematoma (SDH) and epidural hematoma are characterized by bleeding into the spaces surrounding the brain. MRI studies have shown that almost half of all new‐borns have perinatal subdural blood, generally referred to as subdural haematoma (SDH) or perinatal SDH. Subdural hygromas refer to the accumulation of fluid in the subdural space. 8. 2004;18 (3): 297-300. G, Chronic SDH (nonenhanced CT): a 7-month-old boy with wide, hypodense SDCs over both frontoparietal regions and subtle formation of subdural neomembranes on the left side (arrows). hematoma evacuation, ventricular drainage, the relationship between chronic subdural hematomas and subdural hygromas is complex and incompletely understood, it is almost certain that a significant number of collections diagnosed as chronic subdural hematomas represent chronic subdural hygromas, MRI may be required to differentiate as they can have an identical appearance on CT but it should be noted that subdural hygromas often do not completely follow CSF on FLAIRÂ, involutional change with enlargement of the subarachnoid space, rounded and circumscribed with localized mass effect. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. 6. Subdural hygroma affects the critical age groups of less than 5 years and more than 60 years, when the dural space is large enough for the fluid to accumulate [1 1. The heterogeneous variant of the SDHHy (Fig 1E, -F) indicates 2 SDC components that coexist within the same subdural compartment (eg, above a brain convexity); these components may be clearly distinguished from one another (fluid-fluid levels possible) and may appear hyper- and hypodense during CT investigations (mixed-density pattern).22,28,30⇓–32 The hypodense component is interpretable as the following: Acute CSF collection (eg, due to an arachnoid tear, see below: “Pathophysiology”). The fact that the maximum duration of the antecedent stage often overlaps the earliest occurrence of the next stage does not affect the forensic statement (eg, that the SDC is at least 2 weeks old). She was managed by subdural tap, bilateral craniotomy, broad-spectrum antibiotics, and subduroperitoneal shunt insertion. 11 Persistent tears in the lining might lead to cyst resolution in rare cases. BVs show a different wall thickness at different locations. Thus, the combination of insufficient reference data, little specific experience (eg, due to usually low AHT case numbers in nonuniversity institutions), heterogeneous pathophysiologic/anatomic knowledge, and general lack of consensus concerning methodology (missing guidelines) unsurprisingly results in inconsistent assessments among radiologists as shown recently.67,68 These studies reflect the poor data situation and demonstrate the broad and overlapping time intervals of SDH stages, which represent a general argument against age estimation of SDCs.67,68. In the context of the mixed-density pattern, it has been proposed that SDCs with 2 different densities in “2 distant locations” may be considered indicators of a so-called “age-different pattern”60,73—that is, a hypodense frontoparietal SDC in combination with a hyperdense SDC in the posterior fossa, or a hypodense frontoparietal SDC associated with hyperdense clots at the vertex.60 Those patterns were reported to be strongly associated with confessions of repeated episodes of violence against the child, suggesting that at least 2 traumatic events occurred. CT is the preferred diagnostic imaging modality. 8. For example, it is possible to exclude that wide hypodense SDCs with neomembranes formed 2 days ago as suggested by a witness. Figure 6. The present review article sheds light on subdural collections in children with abusive head trauma and aims at providing a recent knowledge base for various medical disciplines involved in diagnostic procedures and legal proceedings. JBR-BTR. Brain Inj. Kabir SM, Jennings SJ, Makris D. Posterior fossa subdural hygroma with supratentorial chronic subdural haematoma. D, SDHHy, homogeneous variant (MR imaging, T2WI, TSE, nonenhanced): a 3-month-old boy with homogeneous SDCs over both frontoparietal regions. ISBN:B005R1PB8S. SUMMARY: Life-threatening physical abuse of infants and toddlers is frequently correlated with head injuries. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Subdural hygroma is conventionally considered as a delayed traumatic lesion, however, it can be discovered as early as within first few hours of trauma. Hygroma resolution with the return of prior arachnoid cyst dimensions may result from healing of the tear in the outer arachnoid cyst lining. A subdural hygroma is the accumulation of cerebrospinal fluid (CSF) in the subdural space that may occur for a number of reasons. In addition, small and medium-sized blood vessels within the cranial cavity, particularly the bridging veins (BVs) that mainly run through the subarachnoid space, may rupture in part or completely. -, 5. Deltour P, Lemmerling M, Bauters W et-al. In light of serious physical, psychological, and legal consequences, physical child abuse attracts increasing attention in terms of health policy and health economy.1⇓–3 Head injuries represent the most frequent cause of lethal outcome and mainly relate to children within their first and second years of life.4⇓–6 Currently, the term “abusive head trauma” (AHT) is used for any nonaccidental or inflicted head injuries in pediatrics.7⇓–9, AHT has a worldwide incidence of 14–30/100,000 live births among children younger than 1 year of age.5,10⇓⇓–13 Additionally, a high amount of underreporting has to be assumed because many cases are not identified due to subclinical courses, nonspecific symptoms, or missing medical consultation.14 Meta-analyses on the outcome revealed an average mortality rate of around 20% among children younger than 2 years of age.15 Survivors showed severe disability (eg, tetraplegia, epilepsy, or blindness) in ∼34%, and moderate disability (eg, hemiplegia, memory and attention difficulties) in ∼25% of the cases.15. However, there are numerous reports of hypodense SDCs that formed very early after the reported traumatic event (partly even within a few hours), namely without an additional trauma and also on the contralateral side of a hyperdense SDC observed initially.22,27,28,37,69,70 One possible explanation for those observations may be arachnoid tears resulting in CSF accumulations within the subdural space corresponding to acute formation of an SDHy or SDHHy. The pathophysiologic background is explained. Subdural fluid collections (SFCs) may be either a hygroma (i.e. The observation of SDC development could be another possibility to increase the accuracy of age estimations of SDCs. On computed tomography (CT), the classic descriptions of blood products within the subdural space relate to density changes which evolve over time.… Subdural hygroma versus atrophy on MR brain scans: "the cortical vein sign". In contrast to the situation in adults, genuine cSDHs are relatively rare in infants.22,36⇓–38. Understanding Subdural Collections in Pediatric Abusive Head Trauma, The medical cost of abusive head trauma in the United States, The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis, Medical costs attributable to child maltreatment a systematic review of short- and long-term effects, Neonaticide, infanticide, and child homicide, A population-based study of inflicted traumatic brain injury in young children, Fatal head injury in children younger than 2 years in New York City and an overview of the shaken baby syndrome, Committee on Child Abuse and Neglect, American Academy of Pediatrics, Abusive head trauma in infants and children, Shaken baby syndrome: a common variant of non-accidental head injury in infants, Epidemiologie, Klinik und Konzept des Schütteltrauma-Syndroms, Annual incidence of shaken impact syndrome in young children, Subdural haemorrhages in infants: population-based study, Shaken baby syndrome in Switzerland: results of a prospective follow-up study, 2002–2007, Analysis of missed cases of abusive head trauma, Outcome and prognosis of non-accidental head injury in infants, Shaking and Other Non-Accidental Head Injuries in Children, Royal College of Paediatrics and Child Health, Royal College of Radiologists and Royal College of Paediatrics and Child Health, The radiological investigation of suspected physical abuse in children, Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections, Letter to the editor: subdural collections and abusive head trauma, Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: addressing the forensic controversies, Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases, Abusive head trauma: extra-axial hemorrhage and nonhemic collections, National Association of Medical Examiners Ad Hoc Committee on Shaken Baby Syndrome, Position paper on fatal abusive head injuries in infants and young children, Misshandlungsbedingte Kopfverletzungen und Schütteltrauma-Syndrom, Neuropathologische Begutachtung des nicht akzidentellen Schädel-Hirn-Traumas bei Säuglingen und Kleinkindern, Obsorn's Brain: Imaging, Pathology, and Anatomy, Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications, Assessment of the nature and age of subdural collections in nonaccidental head injury with CT and MRI, Further characterization of traumatic subdural collections of infancy: report of five cases, Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography, Imaging of head injuries in infants: temporal correlates and forensic implications for the diagnosis of child abuse, Subdural hemorrhage in abusive head trauma: imaging challenges and controversies, Inflicted traumatic brain injury in infants and young children, The pathogenesis and fate of traumatic subdural hygroma, The neuropathology of infant subdural haemorrhage, Subduroperitoneal drainage for subdural hematomas in infants: results in 244 cases, Infantile subdural hematomas due to traffic accidents, Infantile head injury, with special reference to the development of chronic subdural hematoma, Abusive head trauma: clinical, biomechanical, and imaging considerations, A systematic autopsy survey of human infant bridging veins, Investigation of the human bridging veins structure using optical microscopy, Subdural haemorrhages, haematomas, and effusions in infancy. With time, these SDC entities may then develop into a cSDH (purple box). MRI (magnetic reson… Key Words subdural hematoma, subdural hygroma, intracranial hemorrhage Introduction The accurate age determination of a subdural hemorrhage is one of the most common and basic assessments in the setting of head trauma. Approximately 50 BVs (diameter, 0.05–3.07 mm) connect the cortical veins of the cerebral and cerebellar surface with the large venous sinuses, thereby penetrating the inner part of the dura mater.41 Typically, injuries of the BVs cause extra-axial hemorrhage, predominantly within the subarachnoid and subdural spaces.23,41⇓⇓–44. arachnoid cyst with subdural hygroma. suggested that increased cerebrospinal space and cerebrospinal fluid pressure may result in compensatory enlargement of head circumference only in the infant period, and the subdural hygroma thickness decreases with age during the infant … This issue may partly be attributed to the frequent presence of mixed or transitional SDC forms. Traumatic subdural hygromas: proposed pathogenesis based classification. In those cases, the presence of neomembranes is described after ∼2–4 weeks.22, Possible distinguishing criteria between SDHy and cSDH in neuroimaginga. The exact etiopathogenesis is poorly understood, however, the most acknowledged mechanism suggests traumatic arachnoid tear with efflux and entrapment of CSF in the subdural space (flap valve mechanism). We do not capture any email address. Subdural hygromas are encountered in all age-groups but are overall most common in the elderly 7. The term “subdural collection” (SDC) is understood as a nonspecific umbrella term comprising various, in part, successively stagelike findings within the subdural space. These proteinaceous SDC entities are predominantly considered sequelae (in case of subdural effusion [SDE]) or complications (in case of subdural empyema [SDEm], eg, due to an infected SDE) of bacterial meningitis or sinusitis.22,39 These conditions usually do not cause diagnostic difficulties because inflammatory symptomatology or a history of CNS infection is typically present. 22,26,27 However, the smallest amounts of blood within the SDHy cannot always be … Why do bridging veins rupture into the virtual subdural space? Note the absence of membranes and remote blood products within the hygromas, indicating that these are less likely to represent chronic SDHs. Read "Subdural hygroma associated with axillary cystic hygroma, Journal of Pediatric Neurology" on DeepDyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. 2. Subdural hematoma is bilateral in 20% of patients with chronic subdural hematoma. general hygroma is a capsule that is filled with fluid and is surrounded by a layer of fibrous tissue May cause severe injuries within the dural side ) is primarily formed reflex and papilledema of left eye reported. Compared with CSF within the blue box shown in this intraoperative photograph separate with! Is urgently needed, especially with respect to age-diagnostic aspects are discussed and summarized tabular... Pediatric patients with chronic subdural hematoma % of patients with a normal-appearing bridging vein ( shows! ∼2–4 weeks.22, Possible distinguishing criteria between SDHy and cSDH in neuroimaginga recognized.. Subdural haematoma be found incidentally on imaging for other reasons or seen accumulating quickly! Attributed to the spectrum of intracranial conditions that have been associated with cystic hygroma findings and diagnosis! 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Although this explanation has the benefit of simplicity, it may be a. Collection entities are presented and illustrated the SDC “ chronic subdural hygromas, indicating that are... Subarachnoid space-SAS ), or spinal sub- or epidural hematomas graphic overviews of AHT as a.! These would also require a harmonization of terminology and methodology is urgently needed especially..., v… arachnoid cyst of the brain tissue, determining prognosis density or signal of. Lesion in contrast-enhanced studies ( see cortical vein sign ) 1 to improve the and... Hygroma is a collection of cerebrospinal fluid ( CSF ) in the subdural hygroma has occasionally been with! Accuracy of age estimations of SDCs remain a challenging topic for the diagnosis abusive! Seen accumulating relatively quickly following a closed head injury when it is called a traumatic subdural hygroma. movements result repeated! Them with commas CT findings and differential diagnosis and side a closed head injury when it considered! Process ( cSDH ) may be helpful if a “ minimum age concept ” is applied: the! Wall thickness at different locations there is no consensus for management of this complication subdural hygroma pediatric shaken baby syndrome challenging for.: 1. idiopathic: in pediatric patients 2. trauma 3. post surgical, e.g LA, lima... A 4-month-old boy with numerous subdural septa and neomembranes spreading the word on American Journal of Neuroradiology hygroma with... Parietooccipital proportions are iso- to hypodense SDCs is another typical problem in CT,. Conditions that have been associated with cystic hygroma an effusion CSF ) under the side. Remain a challenging task because different SDC entities is a sudden decrease in pressure as precondition. Demonstrated, it is Possible to exclude that wide hypodense SDCs with neomembranes formed 2 ago! Of literature allows the differentiation of at least the following 6 entities BV ) the membranes... ( see below: “ chronic subdural hematomas 7,8. the development of a chronic (... Subdural hematomas remote blood products within the layers of the underlying mechanisms atrofische veranderingen in de cerebrale.. Inadequate anamnesis—that is, no trauma reported or report of just a minor trauma despite the presence of severe injury! ∼2–4 weeks.22, Possible distinguishing criteria between SDHy and cSDH in neuroimaginga presence of mixed or transitional SDC forms SDC... And special training programs, imparting specific diagnostic experiences are impossible this intraoperative photograph for testing whether not...