Post meningitis subdural hygroma: Anatomical and functional evaluation with 99mTc-ehylene cysteine dimer single photon emission tomography/computed tomography
An 8-year-old boy presented to the neurology department. The parents complained that the child was becoming quieter. In addition, he was having difficulty in walking. This was associated with unsteady gait. There was no history of trauma. The child had a history of bacterial meningitis 2 year back for which he was treated and declared cured. Clinical examination was unremarkable except for reduced power (4/5) in both legs. CSF biochemistry, microscopy, and culture were within the normal limits. Magnetic resonance imaging (MRI) findings revealed bilateral frontal subdural CSF collections, suggestive of hygroma, more marked on the left side []. Similar collection was also noted in relation to the right cerebellum [Figure and ]. As subdural hygroma are known to resolve spontaneously and there was no associated hydrocephalus, the clinician decided for a conservative medical management. Because of the parents concern the child was referred to Department of Nuclear Medicine for evaluation of cerebral perfusion. The child was injected 185 MBq (5 mCi) of 99mTc-ECD intravenously and rested in a quiet room. SPECT/CT of the brain was performed under oral sedation 30 min later. The SPECT/CT images confirmed the subdural hygroma [Figure –]. In addition, it also revealed hypoperfusion in bilateral frontal, parietal and temporal cortices [Figure –]. In contrast to the hygroma, hypoperfusion was more marked on the right side. The occipital cortex and cerebellum showed preserved perfusion while the basal ganglia showed relative hyperperfusion. Based on the combination of SPECT/CT findings and clinical signs, the patient underwent drainage of the subdural hygroma with significant clinical improvement.