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A pediatric chronic subdural hematoma: More than meets the eye
Dan Wright1, Erlick A C Pereira1, Shailendra A Magdum1
1Department of Neurosurgery, Division of Paediatric Neurosurgery, West Wing, John Radcliffe Hospital, Oxford, UK, UK.
Insights
A child with a head injury had a subdural hematoma, but imaging revealed an arachnoid cyst with bleeding. Magnetic resonance imaging is crucial for diagnosing this rare condition in children.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Neurotrauma
Background:
- Subdural collections in children often indicate trauma.
- Computed tomography (CT) is typically the first imaging modality used.
Observation:
- A 13-year-old presented with a thin chronic subdural hematoma after minor head trauma.
- Initial CT scans suggested a subdural hematoma but were misleading.
Findings:
- The patient had an underlying arachnoid cyst with simultaneous intra- and extra-cystic bleeding.
- This resulted in an isodense cyst and a concurrent subdural collection, making it radiographically occult.
Implications:
- Arachnoid cysts with bleeding can mimic subdural hematomas on CT.
- Magnetic resonance imaging (MRI) is essential for accurate diagnosis in pediatric patients with subdural collections.
- Early and accurate diagnosis is vital for appropriate management of pediatric head injuries.
Abstract:
We present an unusual case of a 13-year-old child who following minor head injury presented with what appeared to be a thin chronic subdural hematoma on plain computed tomography imaging. The child was found to have an underlying arachnoid cyst. Intra- and extra-cystic bleeding had occurred simultaneously causing an isodense cyst with an accompanying subdural collection. This radiographically occult pathology should be excluded using magnetic resonance imaging in any child presenting with a subdural collection.
