A subdural hygroma is an abnormal accumulation of fluid between two of the membranes that cover the brain, specifically between the dura mater (the outermost and toughest layer) and the arachnoid (the thin, membranous middle layer). This fluid may consist of a combination of blood, plasma, blood cells, and cerebrospinal fluid.
Normally, cerebrospinal fluid, which acts as a cushion for the brain and spinal cord, circulates through the subarachnoid spaces around the brain and spinal cord. However, when a subdural hygroma occurs, this balance is disrupted and the fluid accumulates in the subdural space.
This type of accumulation can occur acutely, as a result of severe head trauma that causes bleeding, or chronically, developing slowly over time due to a variety of factors such as brain atrophy in older adults or blood clotting disorders.
The accumulation of fluid can put pressure on the surrounding brain tissue, which may result in a range of symptoms, from headaches and confusion to seizures and more severe neurological deficits, depending on the size and location of the hygroma.
Causes of a Subdural Hygroma
Head trauma
This is one of the most common triggering factors of a subdural hygroma. A blow to the head can damage the blood vessels near the brain, resulting in bleeding within the subdural space. This bleeding can be acute, as in the case of a car accident or a fall, or chronic, as seen in repeated head injuries, such as those that may occur in boxers or football players.
Brain atrophy
As we age, the brain can undergo a certain degree of atrophy, which means it decreases in size and volume. This process can cause the veins passing through the subdural space to stretch and become more fragile, increasing the risk of bleeding and fluid accumulation.
Coagulopathies
Blood clotting disorders can increase the risk of bleeding in the brain, which may lead to the formation of a subdural hygroma. Some conditions that may predispose individuals to this include hemophilia, thrombocytopenia (low platelet count), or the use of anticoagulant medications that affect the blood’s ability to clot.
Alcohol or drug abuse
Excessive and prolonged alcohol consumption can increase the risk of head injuries and brain damage, which may predispose an individual to the formation of a subdural hygroma. Additionally, the abuse of certain drugs, such as amphetamines or cocaine, can also raise the risk of head trauma and brain hemorrhages.
Brain diseases
Certain neurological diseases, such as hydrocephalus (abnormal accumulation of fluid in the brain), brain tumors, or infections of the central nervous system, can cause changes in intracranial pressure and increase the risk of fluid accumulation in the subdural space.
Symptoms that may be associated with a subdural hygroma
Headaches
Headaches are a common symptom that a person with a subdural hygroma may experience. These headaches can be persistent and may worsen over time.
Confusion
The accumulation of fluid in the subdural space can put pressure on the brain, leading to confusion or difficulty concentrating. The affected person may have trouble remembering simple things or performing everyday tasks.
Memory loss
The pressure caused by the subdural hygroma can affect brain function, including memory. The person may have difficulty remembering recent events or important details.
Changes in mental status
Subdural hygromas can affect a person’s mental status, which may manifest as irritability, sudden mood swings, apathy, or a lack of interest in activities they previously enjoyed.
Difficulty speaking or walking
Depending on the size and location of the subdural hygroma, the pressure exerted on certain areas of the brain can cause speech problems, such as difficulty finding words or speaking clearly. It may also lead to difficulties with walking, coordinating movements, or maintaining balance.
Nausea and vomiting
Increased intracranial pressure can affect the autonomic nervous system, which may lead to gastrointestinal symptoms such as nausea and vomiting.
Seizures
In some cases, a subdural hygroma can irritate the surrounding brain tissue, which may trigger episodes of abnormal electrical activity in the brain, known as seizures. These can manifest as involuntary movements, jerking, or loss of consciousness.
It is important to note that the presentation of symptoms may vary depending on the size, location, and severity of the subdural hygroma, as well as how quickly it develops. If you experience any of these symptoms, especially if they are new or appear suddenly, it is important to seek medical attention immediately for proper evaluation.
Diagnosis
The diagnosis of a subdural hygroma generally involves a comprehensive clinical evaluation and imaging tests. Here are the common diagnostic methods:
Medical history and physical examination
The doctor will begin by gathering information about the patient’s symptoms, medical history, and any history of head injuries. A full physical examination will then be conducted, focusing on assessing neurological function such as coordination, muscle strength, reflexes, and sensation.
Imaging tests
- Cranial computed tomography (CT) scan: This is one of the most common imaging tests used to diagnose a subdural hygroma. A CT scan can provide detailed images of the brain and reveal the presence of fluid accumulation between the brain’s membranes.
- Brain magnetic resonance imaging (MRI): MRI can offer more detailed and precise images than a CT scan, making it a valuable tool for detecting and assessing the extent and location of a subdural hygroma. Additionally, MRI can provide further information about the surrounding brain tissue and potential complications.
Lumbar puncture (spinal tap)
In some cases, a lumbar puncture may be performed to obtain a sample of cerebrospinal fluid and analyze its composition. If a subdural hygroma is suspected, the lumbar puncture may reveal blood or elevated protein levels in the cerebrospinal fluid, suggesting the presence of an underlying hemorrhage.
Electroencephalogram (EEG)
In cases where seizures or changes in mental status are present, an EEG may be performed to assess the brain’s electrical activity and detect any abnormalities that could be associated with the subdural hygroma.
Once a subdural hygroma is diagnosed, the doctor may order additional tests as needed to determine the underlying cause, assess the severity of symptoms, and plan the appropriate treatment. It is important that the diagnosis and management of a subdural hygroma be carried out by trained medical professionals to ensure a safe and effective approach for the patient.
Conclusion
In conclusion, a subdural hygroma is an abnormal accumulation of fluid between the dura mater and the arachnoid, two of the membranes that cover the brain. It can result from various causes, such as head trauma, brain atrophy, blood clotting disorders, alcohol or drug abuse, or underlying brain diseases.
The symptoms of a subdural hygroma can vary, but commonly include headaches, confusion, memory loss, changes in mental status, difficulty speaking or walking, nausea and vomiting, and seizures.
The diagnosis of a subdural hygroma involves a thorough clinical evaluation, including imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) of the brain, and in some cases, a lumbar puncture to analyze the cerebrospinal fluid.
Treatment for a subdural hygroma may vary depending on the cause, the severity of symptoms, and the patient’s overall health, but it may include observation, medications to reduce inflammation, surgical drainage of the accumulated fluid, or a combination of these approaches.
In general, it is important to seek medical attention if symptoms suggestive of a subdural hygroma are experienced, as early diagnosis and treatment can help prevent long-term complications and improve the patient’s quality of life.
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