[An infant with acute subdural hematoma after a minor head injury associated with arachnoid cyst]

Area of Science:

• Pediatric Traumatology
• Neuroimaging
• Neurosurgery

Background:

• Subdural hematoma (SDH) is a serious condition in infants, often resulting from head trauma.
• Arachnoid cysts are congenital abnormalities that can potentially influence the development and progression of intracranial pathologies.
• The interplay between head injury, arachnoid cysts, and SDH requires further investigation, particularly regarding delayed complications.

Observation:

• A 10-month-old infant sustained a head injury from a fall, leading to acute subdural hematoma.
• Initial CT scan showed no hematoma enlargement, but subsequent MRI revealed significant enlargement in the subacute phase (65 days post-injury).
• The subdural hematoma spontaneously diminished without surgical intervention, as confirmed by later MRI (192 days post-injury).

Findings:

• Head injury associated with arachnoid cysts presents a risk for delayed subdural hematoma enlargement.
• Subdural hematomas in this context may exhibit spontaneous resolution, even in the subacute or chronic phases.
• The natural course of subdural hematoma in infants with arachnoid cysts can be unpredictable, necessitating serial imaging.

Implications:

• Clinicians should consider the potential for delayed SDH enlargement in pediatric head injury cases involving arachnoid cysts.
• Conservative management and close radiological monitoring may be appropriate for certain cases of evolving subdural hematoma.
• This case underscores the importance of long-term follow-up imaging after head trauma in infants with pre-existing intracranial cysts.