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NEUROIMAGE
Year : 2015  |  Volume : 63  |  Issue : 2  |  Page : 286

Rapid resolution of an acute subdural hematoma in Dandy Walker syndrome


Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, 06110, Ankara, Turkey

Date of Web Publication5-May-2015

Correspondence Address:
Dr. Erhan Turkoglu
Cukurambar Mah. Ogretmenler Cad. Kardelen Apt. No. 5/6 Cankaya, 06290, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.156319

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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

How to cite this URL:
Ozay R, Fesli R, Balkan S, Turkoglu E, Sekerci Z. Rapid resolution of an acute subdural hematoma in Dandy Walker syndrome. Neurol India [serial online] 2015 [cited 2019 Oct 19];63:286. Available from: http://www.neurologyindia.com/text.asp?2015/63/2/286/156319


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]. [1],[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. [3],[4] 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.

 
  References Top

1.
Park JY, Moon KS, Lee JK, Jeung KW. Rapid resolution of acute subdural hematoma in child with severe head injury: A case report. J Med Case Rep 2013;7:67.  Back to cited text no. 1
    
2.
Mirzai H, Yaldiz C, Eminoðlu M, Orguc S. Ultra fast resolution of acute post-traumatic subdural haematoma. J Neurol Neurosurg Psychiatry 2005;76:1738.  Back to cited text no. 2
    
3.
Tsitsopoulos PP, Pantazis GC, Syrmou EC, Tsitsopoulos PD. Intracranial arachnoid cyst associated with traumatic intracystic hemorrhage and subdural haematoma. Hippokratia 2008;12:53-5.  Back to cited text no. 3
    
4.
Suzuki Y, Kawamata T, Matsumoto H, Kunii N, Matsumoto K. A resolving sign of acute subdural hematoma: From report of two cases. No Shinkei Geka 1998;26:1025-9.  Back to cited text no. 4
    


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