Acute subdural hematoma associated with cerebral infarction in the full-term neonate

Acute subdural hematomas in the full-term neonate are usually thought to be a manifestation of birth trauma. Most commonly, these hematomas are associated with a tentorial tear, and less frequently are secondary to damage to the occipital sinus accompanying occipital osteodiastasis, or to rupture of bridging superficial cerebral convexity veins. We report 6 cases of acute subdural hematoma associated with cerebral infarction (SDH/CI) in term neonates, an entity which has not been well-documented previously. This combination accounted for half the cases of neonatal acute subdural hematomas referred to a pediatric neurosurgical service. All children presented within 72 h of birth, usually after an uneventful delivery, and typically with seizures (5/6), apneic spells (3/6) and a full or bulging fontanel (5/6). Although the patients were referred to the neurosurgical servive for management of a convexity subdural hematoma, the CT scans showed a large associated cerebral infarct, which was hemorrhagic in 5 of the 6 cases, most commonly in the distribution of the middle cerebral artery. Craniotomy was performed in 4 patients, needle aspiration of the subdural hematoma in 1, and no surgical intervention in 1. The outcome in 3 patients, who have been followed for more than 1 year, has been good, with some mild focal neurologic deficits, but no seizure activity. The pathogenesis of this entity is unclear, but the acute subdural hematoma in these cases is probably secondary to the cerebral infarction. Recognition of SDH/CI as a specific entity in term neonates has significant management and possibly medicolegal implications.