Hygroma of the brain is an accumulation of cerebrospinal fluid with blood impurities in the space between the dura mater and the arachnoid mater. The symptom complex includes several main leading syndromes, including general cerebral and focal neurological. Treatment of hygroma is surgical, which is complemented by conservative therapy.
In the classical sense, hygroma is a tumor-like benign neoplasm that forms in the structures of the musculoskeletal system. However, with head injuries, a pathological accumulation also appears in the membranes of the telencephalon.
Definition
Subdural hygroma is an accumulation of fluid under the dura mater as a result of traumatic and surgical damage to the arachnoid membrane.
The cause of occurrence is a traumatic rupture of the arachnoid membrane
Pathological characteristics: cerebrospinal cerebrospinal fluid in the subdural space (arrowheads Fig. 1,2)
Fig. 1 Subdural hygroma of small volume along the convex of the right frontal lobe on MRI is isointense to the cerebrospinal fluid (yellow arrow heads in Fig. 1).
Fig. 2 Subdural hygroma of small volume along the convex of the right frontal lobe on CT is isodense to the cerebrospinal fluid (yellow arrow heads in Fig. 2).
What are the forecasts
If the patient is not old, does not have concomitant tumors or dangerous tumors in the brain, then the prognosis is usually positive. The operation to remove excess fluid in the skull is not complicated, proceeds quickly and in 100% of cases ends with a complete recovery of the patient.
However, there are known cases of relapse; the patient is forced to undergo craniotomy several times throughout his life in order to once again get rid of the tumor. In such cases, the feasibility of installing a permanently worn drainage system for the patient that drains fluid from under the intracranial space is considered. This device is called a hygroperitoneal shunt.
Morphology
The crescent-shaped fluid level along the convex of the right frontal lobe, isodense on CT (yellow arrows in Fig. 3a) and isointense to the cerebrospinal fluid along all PIs on MRI (Fig. 3b and 3c) is an accumulation of cerebrospinal cerebrospinal fluid in the subdural space (yellow arrows in Fig. 3b and 3c). Hygroma is not accompanied by a significant mass effect, because CSF is not pumped into its cavity in a large volume compared to blood, however, there may be a valve mechanism with an increase in the volume of the hygroma.
Fig.3
The computed tomogram determines the spread of cerebrospinal fluid along the convexital surface of the right hemisphere (arrows in Fig. 4a) and the interhemispheric fissure (arrow head in Fig. 4a), MRI in Flair IP shows the isointensity of the MR signal from the subdural hygroma and intraventricular cerebrospinal fluid (yellow arrows in Fig. 4b). The location of the subdural hygroma on the tomogram in the frontal plane according to T2 (yellow arrows in Fig. 4c).
Fig.4
MR tomograms in IP T1 (Fig), T2 (Fig) and Flair (Fig) show an accumulation of cerebrospinal fluid under the dura mater along the surface of the left hemisphere of the cerebrum, and in all IP the cerebrospinal fluid in the subdural space is isointense to the cerebrospinal fluid in the sulci and ventricles.
Fig. 5 Subdural hygroma along the convex of the left parietal lobe on MRI in pulse sequences T1, T2 and Flair.
Accumulation of cerebrospinal fluid under the dura mater on the surface of the left hemisphere of the cerebellum, isointense to the cerebrospinal fluid in the grooves and cisterns along T1 (arrowheads in Fig. 6a), as well as on T2 and Flair (Fig. 6b and 6c).
Fig.6 Sudural hygroma of infratentorial localization.
In Fig. 7, a hygroma is determined supratentorially (arrowheads in Fig. 7b) and infratentorially (Fig. 7b and 7c) isointense on T2 (arrowheads in Fig.) and in a gradient echo T2* (or T2-hemo), without signs of hypointense bands of gemsiderin, which distinguishes hygroma from chronic hematoma (Fig. 7a).
Fig. 7 Combination of supratentorial and infratentorial subdural gyroma on MRI and CT.
Symptoms of pathology
Manifestations of the presence of a tumor in the brain are directly related to its size. A large hygroma is considered a neoplasm containing 250 ml of liquid, and the smallest is 50 ml. Of course, there are smaller tumors, but they are difficult to diagnose and show almost no symptoms.
Often the pathology is accompanied by hematomas or other types of neoplasm, which resonates in the symptoms - they become brighter and more varied, which ultimately makes diagnosis easier, but increases the danger for the patient.
In general, the list of symptoms is as follows:
- sleep disturbance, insomnia;
- pressing headache that occurs for no apparent reason;
- loss of appetite, nausea leading to vomiting;
- visual impairment;
- hearing impairment;
- frequent loss of consciousness;
- memory impairment, both long-term and short-term;
- impaired coordination of movements;
- disruption of the cardiovascular system occurs;
- The patient begins to have asthma attacks.
There are also manifestations of the tumor in human behavior, that is, mental state disorders:
- mood swings;
- unmotivated aggression;
- the patient's behavior loses its logical meaning.
- coma.
Symptoms do not occur all at once or become severe all at once. The disease takes from several weeks to several years to develop.
Related changes
Quite often, subdural hygroma is combined with subdural hematoma, subarachnoid hemorrhage and contusion lesions. Tomograms of the brain reveal a bilateral subdural hygroma, and also on the convexital surface of the left occipital lobe there is a subdural hematoma (arrows in Fig. 8a), slightly hyperintense relative to the brain according to T1 (Fig. 8a), slightly hyperintense according to Flair (Fig. 8c). There are traces of blood in the SAP (arrow heads in Fig. 8c).
Fig. 8 Combination of subdural hematoma on the surface of the occipital lobe, subarachnoid hemorrhage and bilateral subdural hygroma on MRI.
Figure 8b shows the deposition of hemosiderin along the edge of the arachnoid membrane and along the posterior edge of the falx (arrowheads in Figure 8b). In Fig. 8c, in the Flair IP, in the grooves of the temporal lobes and Sylvian fissures, there are stripe-like areas of increased MR signal, which are not differentiated in the other IPs, representing subarachnoid hemorrhage (arrowheads in Fig. 8c).
Fig. 9 Combination of subdural hygroma of contusion lesions on MRI and CT.
The combination of a subdural hygroma along the convex of the left cerebral hemisphere is a crescent-shaped zone of fluid accumulation (arrowheads in Fig. 9a and 9b), isointense to the cerebrospinal fluid and a type I contusion focus in the right parietal lobe (arrows in Fig. 9a and 9b). Figure 9c shows a combination of bilateral subdural hygroma (arrowheads in Figure 9c) with type II contusion lesions (arrows in Figure 9c).
What complications can there be?
The prognosis of the disease with proper treatment is favorable in most cases. It largely depends on the size of the formation in the brain and the rate of its growth.
Complications from hygroma can be varied. There may be severe bleeding, infection, and the development of inflammatory processes.
If left untreated, a large tumor compresses parts of the brain, causing dysfunction and tissue atrophy. The consequences in such a case are irreversible.
Any formation in the brain, including hygroma, is a pathology that requires careful attention and immediate treatment. In the absence of the necessary measures, disruption of the functioning of all body systems may develop.
All data in the article is provided for informational purposes and we do not encourage self-medication options. For more detailed answers, consultation with a specialist is required.
Differential diagnosis
- Subdural hematoma
- Chronic subdural hematoma
- Postoperative subdural empyema
- Asymmetric hydrocephalus
Fig. 11 Subacute bilateral subdural hematoma on T1 (MRI) - Fig. 11a. Chronic phase of massive subdural hematoma on CT - Fig. 11b. and subdural empyema on CT (Fig. 11c).
In Fig. 11, in IP T1 there is an increase in the MR signal from the crescent-shaped subdural zones, which corresponds to a subacute and chronic subdural hematoma, and in the course of evolution, the hematoma is accompanied by the deposition of hemosiderin in the dura and arachnoid membranes. In Fig. there is a crescent-shaped fluid level along the convex of the right frontal lobe, isodense of the cerebrospinal fluid - an accumulation of plasma with lysed formed elements in the subdural space. Compared to a hematoma (in this case in the chronic phase), hygroma is not accompanied by a significant mass effect.
Empyema has an increased density on CT compared to cerebrospinal fluid. Empyema is characterized by a high DWI signal and contrast enhancement of the capsule, as well as reactively inflamed adjacent dura mater.
With asymmetric hydrocephalus, there is no asymmetric displacement of the convexital veins of the brain, which is visible after IV enhancement.
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Author: radiologist, Ph.D. Vlasov Evgeniy Alexandrovich
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Treatment of a bump on the head
Treatment of such hygroma can be conservative or surgical.
For small formations, conservative treatment is used. Patients are observed by a neurologist or neurosurgeon. The doctor monitors the condition of the tumor with frequent examinations. Sometimes exposure to ultraviolet rays is prescribed.
If the hygroma is large and has a strong effect on the brain, surgical removal is prescribed. The process is a craniotomy, in which several small holes are drilled. Through them, thin tubes (drainage) are inserted into the cavity, designed to release excess liquid contents. The operation is performed under general anesthesia. The tubes remain with the patient for several days; during the postoperative period, the person remains in the hospital during this entire time.
Unfortunately, this disease is prone to frequent relapses. If the formation occurs quite often, then the risk of the drainage procedure becomes higher. In such a situation, serious interventions are used - bypass surgery.
If the operation is performed correctly, recovery occurs fairly quickly. There may be some deviations, but they quickly pass. Traditional methods for the treatment of brain tumors are not used.
Diet
The patient's nutrition should be aimed at improving the water-salt balance. Foods that cause fluid accumulation should be excluded from the diet. Instead, vegetables and fruits, steamed meat, and cereals are introduced into the menu.
It is important to lead a healthy lifestyle, exercise with moderate exercise, and walk a lot. Following these recommendations will help maintain the patient's mental and mental fitness.
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Diagnostics
If alarming symptoms appear, you should consult a neurologist. Brain hygroma in a child is treated by a pediatric neurologist, but first you need to be examined by a pediatrician.
First, the doctor will conduct a survey and check your reflexes. Pupil motility and coordination of movements must be assessed. It is impossible to make a diagnosis based on one examination, so additional examinations are required:
- X-ray. This test is the first one the doctor prescribes. It allows you to exclude a hematoma, which has the same symptoms. However, the accumulation of cerebrospinal fluid remains invisible on x-ray, so this study is intermediate.
- Echoencephalography. The examination necessary to exclude vascular pathologies of the brain. Allows you to exclude a number of neurological diseases, dislocation of brain structures, and changes in intracranial pressure.
- Computed tomography or magnetic resonance imaging. The only method for accurately diagnosing cerebral hygroma. Such examinations are safe and harmless, therefore they are used to diagnose subdural hygroma of the brain in children. The method allows you to determine the location and size of the tumor and visualize vascular changes.
Additionally, a lumbar puncture may be performed. This method has a number of contraindications, so it is not always prescribed. A puncture involves collecting a small amount of cerebrospinal fluid with subsequent analysis of its composition. The analysis is necessary to exclude the infectious nature of the disease.
How to recognize the disease?
You can't ignore the symptoms! This may lead to an increase in the tumor. To make a correct diagnosis, it is necessary to conduct a series of neurological studies and undergo an examination.
First of all, you should enlist the help of a neurologist. The doctor will conduct an initial examination and ask questions about your well-being. It is worth answering clearly and accurately, this will help the neurologist make a decision, prescribe a more detailed examination or make a diagnosis.
Most likely, you will receive a referral to do a fluoroscopic scan of the skull. If necessary, you will have to undergo computer or magnetic resonance imaging (CT, MRI).
Using echoencephalography, you can find out the condition of the tumor and understand how much intracranial pressure it exerts.