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A subdural hygroma (SDG) is a collection of cerebrospinal fluid (CSF), without blood, located under the dural membrane of the brain. Most subdural hygromas are believed to be derived from chronic subdural hematomas. They are commonly seen in elderly people after minor trauma, but can also be seen in children following infection or trauma.
Subdural hematomas are most often caused by head injury, in which rapidly changing velocities within the skull may stretch and tear small bridging veins. Much more common than epidural hemorrhages , subdural hemorrhages generally result from shearing injuries due to various rotational or linear forces.
Subdural hemorrhage (SDH) results from tearing of the bridging veins in the subdural space between the dura and arachnoid mater. It can cross the suture lines, but not across dural reflections such as falx cerebri or tentorium cerebelli. [4] Therefore, subdural hematoma always limited to one side of the brain. [3]
Pneumocephalus has also been shown to follow neurosurgical procedures such as deep brain stimulation and hematoma evacuation (e.g., chronic subdural hematoma [6]), where while seemingly innocuous to the patient, may cause brain shift, subsequent stereotactic inaccuracy, and even another surgical intervention.
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This subdural hematoma/epidural hematoma (arrows) is causing midline shift of the brain. Doctors detect midline shift using a variety of methods. The most prominent measurement is done by a computed tomography (CT) scan and the CT Gold Standard is the standardized operating procedure for detecting MLS. [5]
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