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AN UNUSUAL CASE OF SUBDURAL HAEMATOMA

AN UNUSUAL CASE OF SUBDURAL HAEMATOMA. Theuns van Jaarsveld 28 January 2009. CASE REPORT. A 21 yr old male attended the emergency department after “sustaining” a head injury the previous day He was playing football and had headed the ball several times in a row

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AN UNUSUAL CASE OF SUBDURAL HAEMATOMA

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  1. AN UNUSUAL CASE OF SUBDURAL HAEMATOMA Theuns van Jaarsveld 28 January 2009

  2. CASE REPORT • A 21 yr old male attended the emergency department after “sustaining” a head injury the previous day • He was playing football and had headed the ball several times in a row • After this he started to develop a headache but was able to finish the football game

  3. The following day he still had the headache and went to his local emergency department • No loss of conciousness was reported after the incident or any other neurological symptoms

  4. ON EXAMINATION • He was alert and fully orientated • Pupils equal and reactive to light • No focal neurology found in limbs He was given advice on concussion and analgesia and discharged

  5. He re-attended the emergency department 2 weeks later complaining of persistent headaches • Again no focal neurology was found and he was given further advice on analgesia and discharged

  6. 3 weeks after the initial injury he re-attended complaining of headaches • He had vomited 1 time during the previous day and had transient episodes of blurred vision • In view of the persistent symptoms, despite the triviality of the original injury, a CT scan of the head was done

  7. CT SCAN

  8. CT SCAN • Bilateral chronic subdural haematomata • Mild frontal oedema • Left middle cranial fossa arachnoid cyst The case was discussed with neurosurgery and a MRI scan was done of the head

  9. MRI SCAN

  10. He was reviewed at the neurosurgery OPD and it was decided to drain the cyst surgically • He made an uneventfull recovery

  11. DISCUSSION • Intracranial arachnoid cysts account for about 1% of IC space occupying lesions • They are non-tumorous congenital sacs lined with an arachnoid-like membrane and filled with CSF like fluid • Pathologically they can increase in size, remain the same or completely resolve

  12. SUGGESTED EXPLANATION FOR INCREASE IN SIZE • Unidirectional flow through a ball-valve opening in the wall with trapping of CSF in the cyst • Active secretions of fluid by cells lining the cyst wall • Most common site is the middle cranial fossa

  13. SIGNS AND SYMPTOMS • Compression on surrounding tissues by the cyst • Most common Sx and Sx – Increased ICP - Craniomegaly - developmental delay

  14. CHILDREN - craniomegaly - seizures - psychomotor retardation • ADULTS - headaches - seizures - focal neurological deficits

  15. COMPLICATIONS • Acute increase in cyst size • Subdural effusion after rupture • Subdural or intra-cyst bleeding • DIAGNOSES - CT or MRI • PROGNOSIS- untreated arachnoid cysts may cause permanent neurological damage because of progressive expansion or haemorrhage but with trratment most individuals do very well

  16. Pasients who re-attend after minor head injuries represent a high risk group of pasients in whom a CT scan usually yield a positive scan in 14 % of cases • CT scans in these pasients may pick up previously asymptomatic neurological conditions such as aneurysms, abcesses or tumours or unexpected pathology such as a chronic subdural

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