Chronic Subdural Hematoma

Figure hydr_22a_n.jpg to hydr_22c_n.jpg: In central Europe today, the chronic subdural hematoma or -hygroma is a relatively infrequent differential diagnosis of macrocrania. It is based upon a unrecognized, often bilateral subdural hematoma following one or several injuries (incidental injuries). It consists of a xanthochromic fluid rich of protein within a capsule of membranes, which is maintained by repeated bleedings from the bridging veins to the sagittal sinus, and impresses the hemispheres. Figure hydr_22a_n.jpg: Notice the cavity of the hygroma with xanthochromic fluid, the divided outer membrane beneath the dura held with two forceps, and the intact inner membrane over the brain, Figure hydr_22b_n.jpg: and the bridging vein to the sagittal sinus and the residual membrane. The preferred treatment is a subduroperitoneal shunt. Figure hydr_22c_n.jpg: Besides irritability, retardation, anemia, and other signs, a macrocrania and a 'box-like' skull (caput quadratum) is obvious in this 1.7-year-old girl with incidental injury.