Spontaneous microhemorrhages from these fragile new vessels may then occur and lead to a mixture of CSF and blood.86,87 Therefore, it has been suggested that repeated microhemorrhages possibly convert an SDHy into an expanding cSDH.33,50,52,57,66. METHODS: We present a case of a 6-month-old infant with an occipital fracture and slow enlargement of a posterior fossa subdural hygroma that culminated in obstructive hydrocephalus. Rupture of pre-existing arachnoid cysts: arachnoid cysts are congenital or acquired intra-arachnoidal CSF collections occurring infrequently. Macrocephaly is a common presentation of subdural hygroma, as is vomiting due to increased intracranial pressure. The connection between the two conditions would explain why this child has both. While in CT (A), BESS could be misdiagnosed as SDHy, MR imaging (B, T1-weighted image; C, T2-weighted image) clearly demonstrates the presence of BESS. It is our opinion that a wide opening of the external membrane of SACs may predispose the CSF fluid to accumulate within the subdural space, where its absorption is insufficient. The most important diagnostic pitfalls, benign enlargement of the subarachnoid space, and chronic subdural hematoma, are discussed in detail. CSF might therefore be present in small amounts in the dura at all times. This description is strikingly similar to the second morphologic type of SDHy suggested above by Unterharnscheidt.37 However, this CSF-like appearance is also the reason why SDHys harbor a high potential to be confused with cSDHs.57 According to Osborn,55 cSDHs may be defined as “encapsulated collections of sanguineous or serosanguineous fluid confined within the subdural space.” This description, on the other hand, closely resembles the first of Unterharnscheidt's37 morphologic types of SDHy suggesting that cSDHs diagnosed by radiologists can also be termed as SDHys. However, effects on neurodevelopmental outcomes have not been established. Vessels rarely cross through the lesion in contrast-enhanced studies (see cortical vein sign) 1. Frontoparietal SDHys (maximum width of 11 mm) as well as enlarged subarachnoid spaces (maximum width of 4 mm) were found on both sides (A, sagittal T1-weighted image; B, axial T2-weighted image; thin arrows indicate position of the subarachnoid membrane). Imaging is important in the routine postoperative follow-up of these patients, as well as in identifying complications, which often manifest with relatively nonspecific symptoms. SHMs usually resolve spontaneously but a number of these may become a hygroma, a type of external hydrocephalus and precursor of chronic subdural hematoma (CSHM) [7]. Following this concept of rapid formation, SDHys must not be considered automatically as direct remnants or delayed consequence of acute SDHs but SDHy and acute SDH may develop simultaneously as exemplified in Figure 3. In addition, infants with BIH often have a family history of macrocrania [6]. “Three weeks” cannot be a strict borderline, and most of the aforementioned pathophysiologic data regarding cSDH rely on studies in adults. Axial T2-weighted image shows a large left posterior subdural fluid collection of CSF signal intensity (arrow). Ophthalmologic examination revealed sub- and epiretinal hemorrhages distributed over the whole fundus area of both eyes. Objective. Surgeons and pathologists know cSDH as subdural liquid with a dark brown “crank case oil” appearance.47 Many cSDHs also contain a mixture of both CSF and blood, such as breakdown products of hemoglobin or other proteins.55,82 Furthermore, multiple hemorrhages of different ages are supposed to be common (so-called mixed-age SDH).55 This may sometimes also lead to an attenuation approximating that of CSF.
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