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External hydrocephalus: a probable cause for subdural hematoma in infancy

Sarit Ravid1, Joseph Maytal

  • 1Division of Pediatric Neurology, Schneider Children's Hospital, New Hyde Park, NY 11040, USA.

Pediatric Neurology
|April 18, 2003
PubMed

Insights

Subdural hemorrhage in infants may occur with minimal trauma, especially in those with external hydrocephalus. This condition, characterized by widened subarachnoid spaces, can predispose infants to bleeding without significant injury.

Area of Science:

  • Pediatric Neurology
  • Neuroradiology
  • Child Neurology

Background:

  • Subdural hemorrhage is a frequent occurrence in infants, with nonaccidental trauma being the leading cause.
  • Accidental injuries are the second most common etiology for infant subdural hemorrhages.

Observation:

  • Three healthy infants, aged 4-7 months, presented with macrocephaly and were diagnosed with frontal subdural hematoma.
  • These infants had prominent extracerebral cerebrospinal fluid spaces, indicative of external hydrocephalus.
  • No history of trauma or risk factors for child abuse were identified; skull surveys and ophthalmologic exams were normal.

Findings:

  • The infants were neurologically intact and maintained normal developmental milestones during a one-year follow-up.
  • A potential link between external hydrocephalus and subdural hematoma development with minimal trauma is suggested.
  • Stretching of bridging veins within widened subarachnoid spaces may increase the risk of subdural bleeding.

Implications:

  • External hydrocephalus might represent a risk factor for subdural hematoma in infants, even with minimal or no apparent trauma.
  • While child abuse must always be considered and ruled out, it may not be the primary cause in all cases of infant subdural hematoma.
  • This finding warrants further investigation into the pathophysiology of subdural hematoma in infants with specific neuroanatomical variations.

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