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|Year : 2015 | Volume
| Issue : 2 | Page : 286
Rapid resolution of an acute subdural hematoma in Dandy Walker syndrome
Rafet Ozay, Ramazan Fesli, Serdar Balkan, Erhan Turkoglu, Zeki Sekerci
Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, 06110, Ankara, Turkey
|Date of Web Publication||5-May-2015|
Dr. Erhan Turkoglu
Cukurambar Mah. Ogretmenler Cad. Kardelen Apt. No. 5/6 Cankaya, 06290, Ankara
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ozay R, Fesli R, Balkan S, Turkoglu E, Sekerci Z. Rapid resolution of an acute subdural hematoma in Dandy Walker syndrome. Neurol India 2015;63:286
A 55-year-old female patient who had Dandy Walker Syndrome (DWS) was admitted to our hospital with deterioration of mental status after trauma. The computed tomography (CT) scan demonstrated a left frontoparietal acute subdural hematoma (ASDH) with a midline shift, cystic dilataion of the posterior fossa and supratentorial ventriculomegaly [Figure 1]. A repeat CT scan surprisingly showed a remarkable reduction in the size of the hematoma, a decrease of the midline shift and blood in the posterior fossa cyst [Figure 2]. As a result of this, the patient did not require any surgical intervention, either for the hematoma or for the hydrocephalus. Based on these observations, our opinion is that rupture of the arachnoid membrane of the posterior fossa cyst and the effect of gravity facilitated the transportation of the hematoma toward posterior fossa. This was supported by the presence of a low-density band between the ASDH and the inner table of the skull [Figure 2]. ,
|Figure 1: Initial computed tomography scan demonstrating a thick acute subdural hematoma (arrow) in the left frontoparietal lobe with a midline shift (a) and dilatation (arrow) of the posterior fossa (b)|
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|Figure 2: Computed tomography scan 6 h later revealed reduction of the subdural hematoma size (arrow) and its midline shift effect (a), and the redistribution of acute subdural hematoma (arrow) into the posterior fossa cyst (b)|
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Tearing of the arachnoidal membranes allowed the mixing of blood and CSF. The spontaneous cyst wall rupture could have been due to increasing pressure on its wall by the hematoma itself as well as due to the raised intracranial pressure. Redistribution of the ASDH was also seen in the posterior fossa cyst at follow-up imaging studies. , Therefore, enlargement of the posterior fossa cyst following its rupture permitted accumulation of a large amount of hematoma within it leading to a rapid resolution of hydrocephalus, the acute SDH as well as the neurological symptoms.
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[Figure 1], [Figure 2]