[Acute subdural hygroma in the posterior fossa (author's transl)]

A 2-year-old girl was admitted to Chugoku Rosai Hospital one hour after a car accident on July 16, 1978. On admission she was conscious and no physical or neurologic abnormality was found. However, 2 hours and a half after the accident, she was attacked suddenly by generalized convulsion, and then became comatose with apnea. Bilateral horizontal nystagmus to the left, rhythmic constriction and dilation of the pupils reacting to light, and flaccid tetraplegia were recognized. Plain skull films revealed a linear fracture in the right posterior fossa, which crossed the transverse this region. A burr hole was made in the left posterior fossa, and slightly xanthochromic fluid, 30 to 40 microliter in volume, under high pressure was evacuated from the subdural space. A burr hole on the right side disclosed no abnormality. Spontaneous respiration returned immediately and consciousness became clear 5 hours after the surgery. No neurologic deficit was detect and postoperative EEG was normal. She was discharged from the hospital on July 27, 1978. Ten cases of acute subdural hygroma in the posterior fossa, including the present case, were analyzed. This lesion is able to be cured completely by a simple operation even in coma with apnea, if diagnosis made promptly and the surgery is carried out without delay. In cases of acute head injury, it is quite important to have a possibility of the infratentorial lesion in mind and to find it with the aids of plain skull film of Towne's view, CT scan, and VAG if necessary.