Benign extracerebral fluid collection complicated by subdural hematoma and fluid collection: clinical characteristics and management

Abstract

Introduction

Benign extracerebral fluid collection (bECFC) can be complicated by subdural hematoma (SDH) or subdural fluid collection (SDFC). The etiology, natural history, and management strategy for SDH/SDFC in bECFC are not fully understood. We retrospectively reviewed the cases of bECFC patients complicated with SDH/SDFC and tried (1) to confirm the fact that bECFC children are vulnerable to SDH/SDFC, (2) to investigate the clinical significance of 'trauma history' witnessed by a caregiver, and (3) to determine optimal management for them.

Method

Among 213 bECFC patients identified from January 2000 to August 2015, 20 patients (male:female = 14:6; median age, 6.5 months; range 1–16 months) complicated by SDH/SDFC documented with brain imaging were evaluated for their clinical manifestations, radiologic features, and management outcomes. The median follow-up period was 9.5 months. They were divided into two groups (traumatic group versus non-traumatic group) according to whether objective radiologic evidence of head injury was present or not, and the two groups were analyzed for any clinical differences between them. We also evaluated the clinical significance of witnessed traumatic events by caregivers as an additional independent variable in the analysis.

Results

The incidence of SDH/SDFC in bECFC patients was 9.4% (20/213) in our data. In a comparative analysis, the traumatic group is more likely to have 'acute' stage SDH, whereas the non-traumatic group is more likely to have 'chronic' stage SDH. The trauma history witnessed by caregivers did not show clinical significance in the data analysis when included as an independent variable. The prognosis of SDH/SDFC in bECFC patients was favorable without surgery in most of patients regardless of whether the patient has evidence of head trauma or not.

Conclusion

Benign ECFC is vulnerable to SDH/SDFC development. For the bECFC patients complicated by SDH/SDFC, the trauma history witnessed by a caregiver did not show any clinical significance. A 'wait and watch' strategy is sufficient for the management of SDH/SDFC in bECFC patients.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Azais M, Echenne B (1992) Idiopathic pericerebral swelling (external hydrocephalus) of infants. Ann Pediatr (Paris) 39:550–558

    CAS  Google Scholar 

  2. 2.

    Bode H, Strassburg HM (1987) Craniocerebral dysproportion—a contribution to the significance of extracerebral fluid collections in infancy. Klin Padiatr 199:399–402

    CAS  Article  Google Scholar 

  3. 3.

    Ghosh PS, Ghosh D (2011) Subdural hematoma in infants without accidental or nonaccidental injury: benign external hydrocephalus, a risk factor. Clin Pediatr 50:897–903

    Article  Google Scholar 

  4. 4.

    Hellbusch LC (2007) Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-up. J Neurosurg 107:119–125

    PubMed  Google Scholar 

  5. 5.

    Hobbs C, Childs AM, Wynne J, Livingston J, Seal A (2005) Subdural haematoma and effusion in infancy: an epidemiological study. Arch Dis Child 90:952–955

    CAS  Article  Google Scholar 

  6. 6.

    Ikeda A, Sato O, Tsugane R, Shibuya N, Yamamoto I, Shimoda M (1987) Infantile acute subdural hematoma. Childs Nerv Syst 3:19–22

    CAS  Article  Google Scholar 

  7. 7.

    Kapila A, Trice J, Spies WG, Siegel BA, Gado MH (1982) Enlarged cerebrospinal fluid spaces in infants with subdural hematomas. Radiology 142:669–672

    CAS  Article  Google Scholar 

  8. 8.

    McNeely PD, Atkinson JD, Saigal G, O'Gorman AM, Farmer JP (2006) Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. Am J Neuroradiol 27:1725–1728

    CAS  PubMed  Google Scholar 

  9. 9.

    Ment LR, Duncan CC, Geehr R (1981) Benign enlargement of the subarachnoid spaces in the infant. J Neurosurg 54:504–508

    CAS  Article  Google Scholar 

  10. 10.

    Mori K, Sakamoto T, Nishimura K, Fujiwara K (1993) Subarachnoid fluid collection in infants complicated by subdural hematoma. Childs Nerv Syst 9:282–284

    CAS  Article  Google Scholar 

  11. 11.

    Nishimura K, Mori K, Sakamoto T, Fujiwara K (1996) Management of subarachnoid fluid collection in infants based on a long-term follow-up study. Acta Neurochir 138:179–184

    CAS  Article  Google Scholar 

  12. 12.

    Odita JC (1992) The widened frontal subarachnoid space—a CT comparative-study between macrocephalic, microcephalic, and normocephalic infants and children. Child Nerv Syst 8:36–39

    CAS  Article  Google Scholar 

  13. 13.

    Papasian NC, Frim DM (2000) A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma. Pediatr Neurosurg 33:188–193

    CAS  Article  Google Scholar 

  14. 14.

    Ravid S, Maytal J (2003) External hydrocephalus: a probable cause for subdural hematoma in infancy. Pediatr Neurol 28:139–141

    Article  Google Scholar 

  15. 15.

    Vinchon M (2010) Subdural hematoma in infants: can it occur spontaneously? Data from a prospective series and critical review of the literature. Reply. Childs Nerv Syst 26:1485–1485

    Article  Google Scholar 

  16. 16.

    Yew AY, Maher CO, Muraszko KM, Garton HJ (2011) Long-term health status in benign external hydrocephalus. Pediatr Neurosurg 47:1–6

    Article  Google Scholar 

Download references

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Education (2015R1D1A1A01059605).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kyu-Chang Wang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

ESM 1

(XLSX 527 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, H.C., Chong, S., Lee, J.Y. et al. Benign extracerebral fluid collection complicated by subdural hematoma and fluid collection: clinical characteristics and management. Childs Nerv Syst 34, 235–245 (2018). https://doi.org/10.1007/s00381-017-3583-y

Download citation

Keywords

  • Benign extracerebral fluid collection in infancy
  • Subdural hematoma
  • Subdural fluid collection
  • Trauma history