Infantile head injury, with special reference to the development of chronic subdural hematoma

An infantile head injury has unique features in that infants are totally he lpless and dependent on their parents, and biomechanical characteristics of the skull and brain are very different from those of other age groups. The authors reviewed a total of 16 infant head injury patients under 12 months of age who were treated in our hospital from 1989 to 1997. Birth head inju ry was excluded. The most common age group was 3-5 months. Early seizures w ere noted in 7 cases, and motor weakness in 6. Three patients with acute in tracranial hematoma and another 3 with depressed skull fracture were operat ed on soon after admission. Chronic subdural hematomas (SDHs) developed in 3 infants. Initial CT scans showed a small amount of SDH that needed no eme rgency operation. Resolution of the acute SDH and development of subdural h ygroma appeared on follow-up CT scans within 2 weeks of injury. TWO of thes e infants developed early seizures. Chronic SDH was diagnosed on the 68th a nd 111th days after the injuries were sustained, respectively. The third pa tient was the subject of close follow-up with special attention to the evol ution of chronic SDH in view of our experience in the previous 2 cases, and was found to have developed chronic SDH on the 90th day after injury. All chronic SDH patients were successively treated by subduro-peritoneal shunti ng. In conclusion, the evolution of chronic SDH from acute SDH is relativel y common following infantile head injury. Infants with head injuries, espec ially if they are associated with acute SDH and early development of subdur al hygroma, should be carefully followed up with special attention to the p ossible development of chronic SDH.