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Unexplained Fever in the Pediatric Age Group
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Fever in the abused infant and child is quite frequent. The smaller the patient, the higher the chances of fever in a battered child. The exact mechanism of temperature elevation is not clear. Since many infants have multiple fractures roentgenographically similar to subperiostal bleeding, resorption of hematoma can be implicated. Some battered children have suffered brain concussions, with or without retinal bleeding, but whether the fever is of cerebral origin is not known. In some abused infants the presence of fever, leukocytosis, local signs of bone inflammation, and radiological findings will erroneously guide the diagnosis towards low-grade osteomyelitis. Subdural hematoma or subdural effusion may not only follow traumatic delivery, but also concussion during the first months of life, and may appear long before head enlargement or neurological signs are found. A few infants with cerebral palsy or degenerative brain diseases can also present with prolonged low-grade fever and failure to thrive.
Paediatrics
Published in Vincent Helyar, Aidan Shaw, The Final FRCR, 2017
Consider post-contrast imaging.Hydrocephalus, subdural effusion or empyema and intracerebral abscess.Check for sinusitis.
Role of decompressive craniectomy in the management of poor-grade aneurysmal subarachnoid hemorrhage: short- and long-term outcomes in a matched-pair study
Published in British Journal of Neurosurgery, 2021
Hai Yu, Liang Guo, Junhua He, Jun Kong, Min Yang
Of the 21 surgery patients, 15 received initial DC at the first surgery with aneurysm clipping and six later underwent DC alone for deteriorating neurological function; these procedures showed no significant difference in the short-term outcome (p > 0.05). Based on the GOS assessment at the 6-month follow-up, four patients had a great recovery (GR, GOS 5, 19.1%); 19.1% (4/21), 23.8% (5/21), and 14.3% (3/21) patients manifested mild disability (MD, GOS 4), severe disability (SD, GOS 3), and vegetative status (VS, GOS 2), respectively; and five patients died (D, GOS 1, 5/21, 23.8%) within 6 months in the hospital or in the process of rehabilitation (Figure 2(A)). In addition, brain hernia (BH, 2/21, 9.5%), acute subdural hematoma (ASDH, 1/21, 4.8%), chronic subdural effusion (CSDE, 2/21, 9.5%), chronic hydrocephalus (CH, 2/21, 9.5%), and intracranial infection (ICI, 5/21, 23.8%) occurred in patients within 6 months (Figure 3(A)).
Skull angiosarcoma associated with a calcified chronic subdural hematoma
Published in British Journal of Neurosurgery, 2023
Guowen Qin, Peng Xu, Shengyong Lan, Yipu Mao, Yongta Huang, Jin Ye, Youming Liang
A review of pleural cavity sarcomas conducted by Myoui et al.16 revealed that 47% of patients with soft tissue sarcomas in the pleural cavity had a history of chronic pleural inflammatory disease, suggesting that long term pleural inflammation might be an etiological factor affecting the development of soft tissue sarcomas. Literature reports have described subdural sarcomas that were detected in the cavity of a CSDH or in chronic subdural fluid collections that had been diagnosed or treated several years earlier5–8. Nejat et al.6 described the case of a 40-day-old male who developed a subdural hematoma after a head trauma. The patient underwent different surgical interventions over a period of 2 years. Finally, a craniotomy performed at the age of 30 months revealed a huge subdural mass with a pathologic diagnosis of embryonal type rhabdomyosarcoma. The physicians believe that the sarcoma probably developed gradually, because evidence of chronic inflammation and cell proliferation was found in the subdural collection. Lee et al.7 reported the case of a 5-year-old male with multiple subdural masses and chronic subdural effusion (SDE). An SDE was diagnosed when the patient was 2 months old, but he had been clinically stable and remained well for 5 years after receiving a subduroperitoneal shunt. When he later presented with acute headache, nausea, and vomiting, a newly developed tumor was found. The tumor was resected and pathologically diagnosed as embryonal-type rhabdomyosarcoma. The physicians believe that the tumor possibly developed approximately 4 years after the onset of SDE.
Malignant cerebral edema after cranioplasty: a case report and literature review
Published in Brain Injury, 2023
Shaoxiong Wang, Yongxin Luan, Tao Peng, Guangming Wang, Lixiang Zhou, Wei Wu
A 45-year-old man underwent a right intracranial hematoma removal and decompression craniectomy in a local hospital due to a traffic accident in March 2021. His condition gradually improved and then he was released from the hospital 1 month after the surgery. After 2 months of rehabilitation, the patient was measured to reach a GCS score of 14 but left a bone defect in the right frontal-temporal-parietal-occipital part of the skull. Physical examination of the patient on the admission to our center on July 06, 2021 revealed as following: the patient was fluent in speech; bulging of palpable mass through the skull defect was examined, of which volatility was positive; the pupils on both sides were of the same size in circular shape, with 3.0 mm as diameter, and sensitive to light reflection; normal right limb activity was observed, whereas left hemiplegia was examined, no meningeal irritation was tested. The Computed Tomography (CT) of the head at the time of admission revealed a subdural hygroma on the right side of the parietal-occipital region. Following consideration of the formation of the capsule, we performed a subdural effusion capsule resection on July 10, 2021. The cyst fluid is pale yellow cerebrospinal fluid, approximately 150 ml in volume. After the cyst fluid was studied for pathogenic microorganisms, no bacteria were cultured. The postoperative status of the patient was similar to he was before the surgery (Figure 1). Subdural hydromel formed again at 1 week after surgery, and capsular resection did not effectively relieve the subdural hydrogen. Therefore, we intended to perform cranioplasty for the patient (Figure 2).