Acute subdural hematoma post ventricular puncture in infants: A case report and review of the literature

Acute subdural hematoma in infants is often due to non-accidental causes such as shaken baby syndrome or abuse. Occasionally a rupture of the cerebral bridge veins after ventricular puncture can lead to a subdural hematoma in infant. In this article we report the very first case of acute subdural hematoma after ventricular puncture of cerebrospinal fluid. It is a 40-day-old male infant received at the pediatric emergency room for an infectious syndrome. An etiological assessment was carried out including a ventricular puncture of the cerebrospinal fluid. Two days after the puncture, the child develops a sudden alteration of consciousness during hospitalization, with a Blantyre coma score of 3/5. The CT scan performed showed a right subdural parieto-temporal hematoma associated with a right fronto-temporal parietal parenchymal hypodensity. A right temporo-parietal decompressive craniectomy was performed with evacuation of the acute subdural hematoma. Clinical improvement was obtained and the child was discharged after 3 weeks of hospitalization. Acute subdural hematoma post ventricular puncture is rarely reported in the literature. The mechanism would probably be a rupture of the bridging veins by sudden collapse of the parenchyma following rapid and excessive aspiration of cerebrospinal fluid. Its management is medico-surgical. This manuscript further demonstrates the importance of mastering the ventricular puncture technique which must be performed by an experienced neurosurgeon. The ventricular puncture remains a delicate gesture which must be carried out by a qualified neurosurgeon because of the risks of complications such as an acute subdural hematoma. •Infant ventricular puncture is a diagnostic and therapeutic procedure that must be performed by an experienced neurosurgeon; aspiration of cerebrospinal fluid should be done slowly.•Rarely this puncture is complicated by an acute subdural hematoma as in our case.•The mechanism of occurrence of an acute subdural hematoma in infants is different from the mechanisms in older children and adults•The management of a subdural hematoma post ventricular puncture is interdisciplinary.•Our treatment consisted of performing a decompression flap and evacuation of the acute subdural hematoma.