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 secondar y to damage to the occipital sinus accompanying occipital osteodiastas is, or to rupture of bridging superficial cerebral convexity veins. We report 6 cases of acute subdural hematoma associated with cerebral in farction (SDH/CI) in term neonates, an entity which has not been well- documented previously. This combination accounted for half the cases o f neonatal acute subdural hematomas referred to a pediatric neurosurgi cal service. All children presented within 72 h of birth, usually afte r an uneventful delivery, and typically with seizures (5/6), apneic sp ells (3/6) and a full or bulging fontanel (5/6). Although the patients were referred to the neurosurgical servive for management of a convex ity 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 perform ed in 4 patients, needle aspiration of the subdural hematoma in 1, and no surgical intervention in 1. The outcome in 3 patients, who have be en 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 a s a specific entity in term neonates has significant management and po ssibly medicolegal implications.