Challenges and pitfalls in the forensic assessment of posttraumatic extracerebral fluid collections

D. Adam

Abstract: The purpose of this article is to analyze the particularities of these collections and to discuss their medicallegal consequences. Different types of collections were presented together as they have similar prognosis and management. A retrospective analysis of data collected from 46 patients with posttraumatic extra cerebral fluid collections is presented. Asymptomatic patients or those with mild symptoms were conservatively treated (n=27). Surgical evacuation was performed in cases of intracranial hypertension or neurological worsening (n=19). Clinical results are presented using the Glasgow Outcome Scale (GOS). Regarding the group of patients treated conservatively, good results were obtained (GOS score 4 or 5) in 81.4 % of the cases. Regarding the surgical treated group of patients, good results were obtained in 73.6% of the cases. The mortality rate was 18.5%, and 26.3% respectively. Conclusions: posttraumatic extra cerebral fluid collections appear more often in elder patients, often secondary to minor trauma (like falls), but can lead to difficulties in analyzing the case from a medical-legal point of view. The majority of patients whose CT-scans show extra cerebral fluid collections are asymptomatic and the fluid collections are eventually spontaneously resolved. Mortality is in most cases caused by associated cerebral damage or systemic complications.
Keywords: hygroma, hydroma, serous meningitis, posttraumatic extra cerebral fluid collections