Journal Information
Vol. 4. Issue 3.
Pages 211-214 (January 1993)
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Vol. 4. Issue 3.
Pages 211-214 (January 1993)
Hidrocefalia normotensa precedida de higroma subdural
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A. Bárcena Orbe, J.M. Cañizal García, C. Mestre Moreiro, J. Rodríguez Hemández
Servicio de Neurocirugía. Hospital del Aire. Madrid
F. Esteban Alonso*
* Sección de Neurorradiología. Hospital del Aire. Madrid
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Resumen

Se describe el curso clínico de dos pacientes que sufrieron un deterioro nurológico paulatino días después de un traumatismo craneoencefálico, demostrando la tomografía computarizada (TAC) colecciones subdurales carentes de efecto masa e hiperdensas con respecto al líquido cefalorraquídeo. El estudio de la dinámica de la colección subdural sugirió una complianza escasa (presión normal, siendo la latencia del pulso muy reducida y su amplitud extremadamente alta) y un trastorno de la autorregulación (pulso hiperreactivo frente a los pequeños cambios de la PCO2). En ambos pacientes el análisis bioquímico del higroma demostró un elevado contenido proteico, y pocos días después del drenaje del mismo se generó una hidrocefalia comunicante, siendo la clínica, los exámenes complementarios y el resultado del tratamiento compatibles con un síndrome de hidrocefalia de presión normal (HPN). Se concluye que la presencia de higromas hiperdensos en la TAC, en pacientes con progresiva degradación neurológica y datos sugerentes de escasa complianza y/o trastorno de la autorregulación incongruentes con el volumen de las colecciones subdurales, podría hacer sospechar la inminente aparición de una HPN.

Palabras clave:
Higroma
Traumatismo
Hidrocefalia
Dinámica licuoral
Autorreguladón
Demencia
Summary

The authors describe the clinical course of two patients who developed progressive neurological deficit after suffering a mild head injury. Neurological deterioration was related to the presence of subdural hygromas which appeared in the C. T. scan as slightly hyperdense collections (complex hygroma) in comparison with the C. S. F. The hydrodynamic study at the level of the subdural hygroma revealed that brain compliance was exhausted and cerebro-vascular reactivity much impaired. In both cases the surgically evacuated fluid showed a high protein contento Few days after hygroma evacuation a transient clinical improvement ensued, but then, both patients developed a normal pressure hydrocephalus syndrome.

Thus, a progressive neurological deterioration occurring in patients with postraumatic complex subdural hygroma who show a marked reduction of intracranial compliance should rise the suspicion that a normal pressure hydrocephalus is prone to develop.

Key words:
Hygroma
Head injury
Hidrocephalus
C. S. F. dynamics
Dementia

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