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Bilateral subdural effusion and subcutaneous swelling with normally functioning csf shunt
1Departments of Paediatrics and Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Insights
A child with tuberculous meningitis and hydrocephalus developed a rare subcutaneous fluid collection near a shunt tube. Drainage resolved the swelling and subdural effusion, suggesting a unique complication.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Neurology
Background:
- Hydrocephalus management often involves cerebrospinal fluid (CSF) shunting.
- Tuberculous meningitis (TBM) is a severe infection requiring prompt treatment.
- Ventricular shunts can be complicated by various issues, including infections and CSF collections.
Observation:
- A pediatric patient with hydrocephalus secondary to TBM presented with a subcutaneous fluid collection at the ventriculoperitoneal shunt entry site.
- Imaging revealed decompressed ventricles alongside bilateral frontoparietal subdural hygromas.
- The subcutaneous swelling correlated with the subdural fluid collections.
Findings:
- The subcutaneous fluid collection was identified as a unique complication associated with ventriculoperitoneal shunting in TBM.
- Bifrontal burr hole drainage successfully resolved both the subdural effusion and the subcutaneous scalp swelling.
- The pathogenesis of this specific complication was considered.
Implications:
- This case highlights a rare but treatable complication of CSF shunting in the context of tuberculous meningitis.
- Prompt recognition and appropriate surgical intervention (burr hole drainage) can lead to favorable outcomes.
- Further investigation into the pathogenesis of such shunt-related complications is warranted.
Abstract:
We report a child with hydrocephalus due to tuberculous meningitis who developed a subcutaneous fluid collection around the ventriculoperitoneal shunt tube entry point, after one month of shunting. On investigation, he had decompressed ventricles with bilateral fronto parietal subdural hygroma. Bifrontal burr hole drainage helped resolution of both subdural effusion and subcutaneous scalp swelling. This complication is unique and its pathogenesis has been postulated.