Neuropediatrics 2023; 54(04): 239-243
DOI: 10.1055/a-1893-2559
Original Article

Factors Associated with Nontraumatic Spontaneous Subdural Hematomas in Pediatric Patients

1   Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
,
1   Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
,
1   Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
,
1   Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
,
1   Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
,
1   Department of Neurosurgery, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
› Author Affiliations

Abstract

Objective In our study, we aimed to summarize the etiology of subdural hematoma that was not traumatic and required operation in pediatric patients. The subdural hematoma characteristics, possible etiologies, and treatment, as well as the patient outcomes, were analyzed.

Methods A retrospective examination was made of pediatric patients with subdural hematoma who were operated on at Ümraniye Training and Research Hospital. Patients with a history of trauma were excluded. Data on patient sex, age, bleeding location, type of hematoma based on computed tomography imaging, surgical treatment, presenting symptoms, presence of comorbidities, Glasgow Coma Scale, thrombocyte counts, and international normalized ratio values were recorded.

Results Of the 19 patients included in the study, 4 were female and 15 were male. Their ages ranged between 0 and 15 (mean = 5.84) years. In 57.8% of the patients, comorbidities, including acute myeloid leukemia, a history of shunt operation, epilepsy, mucopolysaccharidosis, known subdural effusion, autism, coagulopathy, ventricular septal defect/tetralogy of Fallot, cerebrospinal fluid leakage after baclofen pump administration, Marfan's syndrome, and late neonatal sepsis were present, while 21% had arachnoid cysts and 21% had no reported comorbidities.

Conclusion This study suggests that, in pediatric patients with subdural hematoma with an amount of bleeding requiring surgical management, any underlying comorbidities should be investigated regardless of the presence of a history of trauma. While investigating systemic diseases, special attention should be paid to the presence of arachnoid cysts or disruption in cerebrospinal fluid dynamics along with a history of hematologic diseases.



Publication History

Received: 26 May 2022

Accepted: 05 July 2022

Accepted Manuscript online:
06 July 2022

Article published online:
28 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Jayawant S, Rawlinson A, Gibbon F. et al. Subdural haemorrhages in infants: population based study. BMJ 1998; 317 (7172): 1558-1561
  • 2 Barlow KM, Minns RA. Annual incidence of shaken impact syndrome in young children. Lancet 2000; 356 (9241): 1571-1572
  • 3 Hobbs C, Childs AM, Wynne J, Livingston J, Seal A. Subdural haematoma and effusion in infancy: an epidemiological study. Arch Dis Child 2005; 90 (09) 952-955
  • 4 O'Driscoll K, Meagher D, MacDonald D, Geoghegan F. Traumatic intracranial haemorrhage in firstborn infants and delivery with obstetric forceps. Br J Obstet Gynaecol 1981; 88 (06) 577-581
  • 5 Hayashi T, Hashimoto T, Fukuda S, Ohshima Y, Moritaka K. Neonatal subdural hematoma secondary to birth injury. Clinical analysis of 48 survivors. Childs Nerv Syst 1987; 3 (01) 23-29
  • 6 Towbin A. Central nervous system damage in the human fetus and newborn infant. Mechanical and hypoxic injury incurred in the fetal-neonatal period. Am J Dis Child 1970; 119 (06) 529-542
  • 7 Hanigan WC, Morgan AM, Stahlberg LK, Hiller JL. Tentorial hemorrhage associated with vacuum extraction. Pediatrics 1990; 85 (04) 534-539
  • 8 Abroms IF, McLennan JE, Mandell F. Acute neonatal subdural hematoma following breech delivery. Am J Dis Child 1977; 131 (02) 192-194
  • 9 Vinchon M, Delestret I, DeFoort-Dhellemmes S, Desurmont M, Noulé N. Subdural hematoma in infants: can it occur spontaneously? Data from a prospective series and critical review of the literature. Childs Nerv Syst 2010; 26 (09) 1195-1205
  • 10 Minns RA. Subdural haemorrhages, haematomas, and effusions in infancy. Arch Dis Child 2005; 90 (09) 883-884
  • 11 Fung ELW, Sung RYT, Nelson EAS, Poon WS. Unexplained subdural hematoma in young children: is it always child abuse?. Pediatr Int 2002; 44 (01) 37-42
  • 12 Anderst JD, Carpenter SL, Presley R. et al. Relevance of abusive head trauma to intracranial hemorrhages and bleeding disorders. Pediatrics 2018; 141 (05) e20173485
  • 13 McKeag H, Christian CW, Rubin D, Daymont C, Pollock AN, Wood J. Subdural hemorrhage in pediatric patients with enlargement of the subarachnoid spaces. J Neurosurg Pediatr 2013; 11 (04) 438-444
  • 14 Jayawant S, Parr J. Outcome following subdural haemorrhages in infancy. Arch Dis Child 2007; 92 (04) 343-347
  • 15 Liu Z, Xu P, Li Q, Liu H, Chen N, Xu J. Arachnoid cysts with subdural hematoma or intracystic hemorrhage in children. Pediatr Emerg Care 2014; 30 (05) 345-351
  • 16 Tinois J, Bretonnier M, Proisy M, Morandi X, Riffaud L. Ruptured intracranial arachnoid cysts in the subdural space: evaluation of subduro-peritoneal shunts in a pediatric population. Childs Nerv Syst 2020; 36 (09) 2073-2078
  • 17 Zakaria Z, Kaliaperumal C, Crimmins D, Caird J. Neurosurgical management in children with bleeding diathesis: auditing neurological outcome. J Neurosurg Pediatr 2018; 21 (01) 38-43
  • 18 Hung KL. Pediatric abusive head trauma. Biomed J 2020; 43 (03) 240-250
  • 19 Morris MW, Smith S, Cressman J, Ancheta J. Evaluation of infants with subdural hematoma who lack external evidence of abuse. Pediatrics 2000; 105 (3 Pt 1): 549-553
  • 20 Karibe H, Kameyama M, Hayashi T, Narisawa A, Tominaga T. Acute subdural hematoma in infants with abusive head trauma: a literature review. Neurol Med Chir (Tokyo) 2016; 56 (05) 264-273
  • 21 Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics 2001; 108 (03) 636-646
  • 22 Hong JC, Kim MS, Chang CH, Kim SH. Arachnoid cyst with spontaneous intracystic hemorrhage and chronic subdural hematoma. J Korean Neurosurg Soc 2008; 43 (01) 54-56
  • 23 Hopkin J, Mamourian A, Lollis S, Duhaime T. The next extreme sport? Subdural haematoma in a patient with arachnoid cyst after head shaking competition. Br J Neurosurg 2006; 20 (02) 111-113
  • 24 Kawanishi A, Nakayama M, Kadota K. Heading injury precipitating subdural hematoma associated with arachnoid cysts–two case reports. Neurol Med Chir (Tokyo) 1999; 39 (03) 231-233
  • 25 Mori K, Yamamoto T, Horinaka N, Maeda M. Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma 2002; 19 (09) 1017-1027
  • 26 Parsch CS, Krauss J, Hofmann E, Meixensberger J, Roosen K. Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 1997; 40 (03) 483-490
  • 27 Sprung C, Armbruster B, Koeppen D, Cabraja M. Arachnoid cysts of the middle cranial fossa accompanied by subdural effusions–experience with 60 consecutive cases. Acta Neurochir (Wien) 2011; 153 (01) 75-84
  • 28 Yamakawa H, Sakai H, Nishimura Y. et al. Intracranial arachnoid cyst with subdural hematoma. J Clin Neurosci 1997; 4 (04) 493-498
  • 29 Takayasu T, Harada K, Nishimura S, Onda J, Nishi T, Takagaki H. Chronic subdural hematoma associated with arachnoid cyst. Two case histories with pathological observations. Neurol Med Chir (Tokyo) 2012; 52 (02) 113-117
  • 30 Kusuno K, Yoshida Y, Takahashi A, Ishii S. Chronic subdural hygroma caused by rupture of arachnoid cyst. As a probable course of chronic subdural hematoma–case report [in Japanese]. Neurol Med Chir (Tokyo) 1984; 24 (05) 349-354
  • 31 Park SH, Lee SH, Park J, Hwang JH, Hwang SK, Hamm IS. Chronic subdural hematoma preceded by traumatic subdural hygroma. J Clin Neurosci 2008; 15 (08) 868-872
  • 32 Greeley CS. Conditions confused with head trauma. In: Jenny C. ed. Child Abuse and Neglect: Diagnosis, Treatment and Evidence. St. Louis, MO: Saunders Elsevier; 2010: 252-259
  • 33 Mattle H, Kohler S, Huber P, Rohner M, Steinsiepe KF. Anticoagulation-related intracranial extracerebral haemorrhage. J Neurol Neurosurg Psychiatry 1989; 52 (07) 829-837
  • 34 Fayed IF, Chang Y, Keating RF, Reddy SK. Spontaneous subdural haematoma in a paediatric patient on anticoagulant therapy. BMJ Case Rep 2017; 2017: bcr-2017–223041
  • 35 Mori K, Sakamoto T, Nishimura K, Fujiwara K. Subarachnoid fluid collection in infants complicated by subdural hematoma. Childs Nerv Syst 1993; 9 (05) 282-284
  • 36 Alvarez LA, Maytal J, Shinnar S. Idiopathic external hydrocephalus: natural history and relationship to benign familial macrocephaly. Pediatrics 1986; 77 (06) 901-907
  • 37 Ravid S, Maytal J. External hydrocephalus: a probable cause for subdural hematoma in infancy. Pediatr Neurol 2003; 28 (02) 139-141
  • 38 Briner S, Bodensteiner J. Benign subdural collections of infancy. Pediatrics 1981; 67 (06) 802-804
  • 39 Cinalli G, Zerah M, Carteret M. et al. Subdural sarcoma associated with chronic subdural hematoma. Report of two cases and review of the literature. J Neurosurg 1997; 86 (03) 553-557
  • 40 Mandal A, Priyadarshi M, Jat K, Kabra SK. Infantile tremor syndrome and subdural hemorrhage in an infant with cystic fibrosis. J Trop Pediatr 2017; 63 (04) 328-332