Collection of cerebrospinal fluid in subdural space after aneurysmal subarachnoid hemorrhage

Abstract

Introduction: subarachnoid hemorrhage, a cerebrovascular disease, is usually caused by aneurysms and is associated with significant impact on morbidity and mortality of affected patients. One of the complications derived from this disease are cerebrospinal fluid collections in the subdural space. Case report: a 68-year-old black female patient, inveterate smoker and hypertensive, who was admitted to the center after suffering sudden headache with loss of consciousness and fall to the floor without cranioencephalic trauma, the physical examination revealed manifestations of drowsiness, psychomotor agitation, disorientation in time, space, person and miotic pupils, some signs and symptoms indicative of endocranial hypertension. In the initial imaging study by simple computed axial tomography of the skull, the subarachnoid and subdural spaces were not expanded and a diffuse bleeding pattern corresponding to a subarachnoid hemorrhage was observed, corresponding to a Fisher 4 subarachnoid hemorrhage. After 24 hours of evolution, due to the worsening of the neurological symptoms (nuchal rigidity, non-reactive pupils, right anisocoria and Glasgow 7), an evolution computed axial tomography was performed, which showed a decrease in the width of the III ventricle, interstitial edema, midline displacement and accumulation of cerebrospinal fluid in the fronto parietotemporal-subdural space. Conclusions: the diagnosis of external hydrocephalus was established, a rare condition that compromises the recovery and survival of the patient. It is important to differentiate this type of hydrocephalus from other subdural cerebrospinal fluid collections.

Keywords

• líquido cefalorraquídeo
• espacio subdural
• hemorragia subaracnoidea
• aneurisma intracraneal
• aneurisma roto
• aneurisma.