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Infantile chronic subdural hematoma of the posterior fossa diagnosed by computerized tomography. Case report
Insights
A 9-week-old infant with vomiting and neurological signs had acute hydrocephalus and subdural hematoma. Treatment resolved symptoms, but the infant
Area of Science:
- Pediatric Neurology
- Neuroradiology
Background:
- Infantile hydrocephalus and subdural hematomas are critical conditions requiring prompt diagnosis.
- Clinical presentation can include vomiting, tense fontanel, and neurological deficits.
Observation:
- A 9-week-old infant presented with persistent vomiting, opisthotonos, and hypertonicity.
- Computerized tomography (CT) revealed acute hydrocephalus and a posterior fossa subdural hematoma.
Findings:
- The cerebellum and brain stem showed higher density and contrast enhancement compared to normal white matter.
- The subdural hematoma was isodense with normal cerebral white matter.
- Postoperative CT confirmed persistent higher density in the cerebellum and brain stem.
Implications:
- This case highlights unusual CT findings in infantile hydrocephalus and subdural hematoma.
- The persistent increased density of the cerebellum and brain stem warrants further investigation.
- Early surgical intervention (shunt and craniectomy) effectively treated the acute condition.
Abstract:
A 9-week-old infant manifested continuous vomiting for 1 week accompanied by a tense fontanel, "sun setting" of the eyes, frequent opisthotonos, and hypertonicity. The head circumference was at the 50th percentile. Computerized tomography (CT) revealed acute hydrocephalus and a posterior fossa subdural hematoma. The brain stem and cerebellum were of greater density (54 Hounsfield units) than normal cerebral white matter (42 Hounsfield units) whereas the subdural hematoma was the same density as normal cerebral white matter ("isodense"). The cerebellum and brain stem became enhanced by contrast (68 Hounsfield units), but no enhancement occurred in the cerebral white matter or subdural hematoma. A shunt followed by occipital craniectomy resolved both the hydrocephalus and subdural hematoma. Repeat CT scan 15 days postoperatively disclosed continuing higher density of the cerebellum and brain stem (60 Hounsfield units) relative to cerebral white matter. Increased density of the infantile cerebellum has been noted previously but not to the same extent as in this patient.