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Infantile head injury, with special reference to the development of chronic subdural hematoma
1Department of Neurosurgery, Kyungpook National University, School of Medicine, Korea. shwang@knu.ac.kr
Insights
Infantile head injuries can lead to chronic subdural hematomas (SDHs) in infants. Careful follow-up is crucial for infants with acute SDH and subdural hygroma to monitor for chronic SDH development.
Area of Science:
- Pediatrics
- Neurology
- Trauma Surgery
Background:
- Infantile head injuries present unique challenges due to infant helplessness and distinct biomechanical properties of the infant skull and brain.
- This study reviews 16 infant head injury cases under 12 months, excluding birth injuries, treated between 1989 and 1997.
Observation:
- The most affected age group was 3-5 months.
- Early seizures occurred in 7 infants, and motor weakness in 6.
- Acute intracranial hematomas and depressed skull fractures required immediate surgical intervention in 3 patients each.
Findings:
- Three infants developed chronic subdural hematomas (SDHs) after initial CT scans showed small, non-emergency acute SDHs.
- Resolution of acute SDH and development of subdural hygroma were observed within 2 weeks, with two infants experiencing early seizures.
- Chronic SDH diagnosis occurred between 68 and 111 days post-injury, with all cases successfully treated via subduro-peritoneal shunting.
Implications:
- The evolution from acute to chronic subdural hematoma is a significant concern in infantile head injuries.
- Infants with head trauma, particularly those with acute SDH and developing subdural hygroma, require vigilant monitoring for potential chronic SDH.
- This highlights the importance of long-term follow-up protocols for infant head injury management.
Abstract:
An infantile head injury has unique features in that infants are totally helpless and dependent on their parents, and biomechanical characteristics of the skull and brain are very different from those of other age groups. The authors reviewed a total of 16 infant head injury patients under 12 months of age who were treated in our hospital from 1989 to 1997. Birth head injury was excluded. The most common age group was 3-5 months. Early seizures were noted in 7 cases, and motor weakness in 6. Three patients with acute intracranial hematoma and another 3 with depressed skull fracture were operated on soon after admission. Chronic subdural hematomas (SDHs) developed in 3 infants. Initial CT scans showed a small amount of SDH that needed no emergency operation. Resolution of the acute SDH and development of subdural hygroma appeared on follow-up CT scans within 2 weeks of injury. Two of these infants developed early seizures. Chronic SDH was diagnosed on the 68th and 111th days after the injuries were sustained, respectively. The third patient was the subject of close follow-up with special attention to the evolution of chronic SDH in view of our experience in the previous 2 cases, and was found to have developed chronic SDH on the 90th day after injury. All chronic SDH patients were successively treated by subduro-peritoneal shunting. In conclusion, the evolution of chronic SDH from acute SDH is relatively common following infantile head injury. Infants with head injuries, especially if they are associated with acute SDH and early development of subdural hygroma, should be carefully followed up with special attention to the possible development of chronic SDH