CHRONIC SUBDURAL HEMATOMA IN INFANCY

Abstract

A review of 24 cases of infantile subdural hematoma during a 15 year period shows the condition to be rare in Denmark. Patients treated by wide excision of the subdural membranes can be grouped according to probable pathogenesis, and the prognosis depends on the condition of the brain. Patients with definite or presumed postnatal head injury often had increased head circumference, bulging fontanelle and hemorrhages in the fundi, but prognosis was good. Patients with a pre-or perinatal brain lesion most often had a small skull with no bulging of the fontanelle and a uniformity poor prognosis. Histologically the subdural membranes showed differences depending upon the age of the membranes, but there were no differences correlated with the probable pathogenesis, and the membranes were identical with membranes from adult patients. In membranes 1 month old or more, large abnormal capillaries were seen, especially in the outer membrane and often bordering on the fluid interior of the hematoma. The literature and the present survey indicate that the reaction of the dura is a nonspecific reaction to noxious stimuli, and that effusion through the abnormal capillaries plays an important role in dilution of an original hematoma and perpetuation of fluid accumulation; but also that the lesion has a natural tendency to heal. It is suggested that in most cases treatment should be restricted to a few subdural punctures and if this is insufficient then to trephination with opening of the membranes and evacuation of the hematoma.