Acute Traumatic Subdural Hygroma *

A complication of head injury which is similar to, but distinct from the better known entity of subdural hematoma, is that of "subdural hygroma." This term was introduced by Dandy' to describe the appearance or development of abnormal collections of fluid in the subdural space. Dandy ascribed this condition to three possible etiologies: cranial trauma with leakage of cerebrospinal fluid, mixed with blood or plasma, into the subdural space through a "ball-valve" tear in the arachnoidal membrane; extra-dural infection, usually in the mastoid bone, with production of inflammatory transudate; and rupture of the ventricular system or arachnoid, again with leakage of fluid beneath the dura, in cases of chronic internal hydrocephalus. It is with subdural hygroma resultant from the first cause listed, head injury, that this article is concerned. Wycis published, in 1945, a report of seven personal cases of this condition and summarized all previous communications upon the subject of traumatic hygroma. Ninety-nine cases were listed in all. That there have undoubtedly been many more instances of subdural hygroma found operatively or at autopsy, recognized or unrecognized, is indicated by McConnell's' discovery of effusion beneath the dura in 32 of 63 cases of head trauma operated upon. Payr,7 in Germany, was first to describe what has come to bear the name of "subdural hygroma." His cases resulted from bullet wounds (World War I). Naffziger,' Cohen,' McConnell,' and Scott8 made traumatic subdural effusions the subject of subsequent reports, indicating the surgical treatment and variations of the syndrome. Abbott, Due, and Nosik' reported the condition as a complication of blast concussion. The development of subdural hygroma in infants, again as the result of injury, has been brought to attention by Ingraham and Matson.' However, in spite of the numerous communications upon this subject, the condition is not generally thought of as a complication of head injury, whereas subdural hematoma immediately comes to mind when headache, drowsiness, slowness of the pulse, and mental and neurological phenomena develop after cranial trauma.