Acute Subdural Hematoma in Infancy

Acute subdural hematoma in infant has several peculiar characteristics compared with adult case. From our 10 cases experience in the past, the correlations between the onset and interval up to the operation and prognosis were evaluated. In addition the correlation between the hematoma volume and location and prognosis was discussed. Among 5199 cases of head injury below age 12 (Aug. 1965-Sept. 1971), 10 cases (0.2%) of acute subdural hematoma were included which occupied 7.6% of total 131 operated cases of infant head injury. Namely 6 cases of sole subdural hematoma and 4 cases of combined subdural hydroma or epidural hematoma were picked up among total 52 cases of intracranial hematoma and hydroma. Half of the total cases (5 in number) were found below 1 year of age which is often beckoned even by minor trauma. As for the initial symptoms, vomiting and convulsion were most often and consciousness disturbance followed soonafter. Nine cases manifested consciousness disturbance upon admission, preretinal hemorrhage in 4 cases, anisocoria in 5 cases and hemiparesis in 7 cases were recorded, however, no correlation was observed between preretinal hemorrhage and prognosis. As for the interval up to the operation, 3 cases underwent operative intervension in shorter period showed good recovery, even though abrupt clinical picture aggravation was observed. Two cases developed clinical signs even in a few hours after accident which were transfered to our institute several hours later died due to the massive intracranial hematoma. Two cases associated with blunt cerebral contusion, epidural hematoma or transverse sinus rupture ended in poor prognosis. Three cases with slowly progressing clinical pictures showed good prognosis even when the operation was performed in the delayed stage. In conclusion, the infant subdural hematoma was not infrequently beckoned by minor trauma and the clinical picture used to proceed as in the adult case associated with sinus rupture. The early diagnosis and prompt operative therapeutic procedure should be mostly advisable in infantile subdural hematoma accordingly.