Article Figures & Data
Figures
- Fig 1.
Axial fluid-attenuated inversion recovery MR image showing prominent CSF equivalent subarachnoid spaces in both frontal regions. No subdural hemorrhage is noted.
- Fig 2.
Axial fluid-attenuated inversion recovery MR of same patient as in Fig 1 done 19 days later (patient remained hospitalized) now showing an isointense area in the left subdural space, consistent with a hematoma. The subarachnoid CSF space is seen clearly separate from the overlying subdural space containing the hematoma.
- Fig 3.
Axial CT scan showing prominent subarachnoid spaces in both frontal regions.
- Fig 4.
Axial fluid-attenuated inversion recovery MR sequence showing thin bilateral subdural hematomas that are seen separate from the underlying subarachnoid space.
- Fig 5.
Axial T2-weighted MR image also showing the thin bilateral subdural hematomas.
Tables
Clinical and imaging characteristics of patients*
Patient Age at Diagnosis of Subdural Hematoma (mo)/Sex Head Circumference at Subdural Hematoma Diagnosis (cm) Presenting Signs and Symptoms Imaging Findings Treatment 1 8.5/M 47.5 (normal) Bulging fontanelle, nausea, and lethargy 4-mm-thick right acute SDH Observation alone 2 3.9/M 44 (macrocephalic) Macrocephalic but otherwise asymptomatic; HC >98th percentile corrected for age; normal fundi; developmentally normal Thin SDH present bilaterally measuring 5 mm thick Observation alone 3 4.7/F 45.8 (macrocephalic) Macrocephalic, bulging fontanelle; irritable, spasticity Bilateral 18-mm-thick chronic SDHs Bilateral subdural–peritoneal shunts
Bifrontal craniotomy
4 17.8/M 50 (normal) Fall from own height causing linear right parietal skull fracture and bilateral SDHs; returned 6 weeks later with irritability and bulging fontanelle Bilateral subacute SDHs measuring 10 mm on right and 9 mm on left, and right parietal linear nondisplaced skull fracture Burrhole drainage 6 weeks following trauma
Required bilateral subdural peritoneal shunts 12 weeks after the trauma
5 3.6/M 45.9 (macrocephalic) Macrocephalic but otherwise asymptomatic; fundus normal Prominent pericerebral fluid spaces noted on referral for evaluation of macrocephaly; MRI 1 week later showed thin bilateral subdural hemorrhage with membranes (11 mm on right and 18 mm on left) Bilateral burrhole drainage 19 days following referral
Left subdural peritoneal shunt inserted 1 week later
6 6.3/F Not recorded Fever and upper respiratory tract infection symptoms, lethargy, and spasticity Initial MRI showed prominent SAS; second MRI done during hospitalization showed an 8-mm left subdural hematoma Observation alone 7 7/M 45.5 Motor vehicle crash— Patient was in a proper car seat, not ejected; Presented with decreased level of consciousness, vomiting, and respiratory pauses, and was therefore intubated and admitted to an intensive care unit. Found to have retinal and preretinal hemorrhages on fundoscopy Initial CT showed an 11-mm-thick left acute SDH with a 4-mm midline shift and pericerebral fluid collections. MRI done in the days that followed was interpreted as showing SDHs of various ages in multiple compartments including the perifalcine region No surgical intervention for the subdural hematoma; developed seizures that were treated with carbamazepine HC indicates head circumference; SDH, subdural hematoma; SAS, subarachnoid space.
* Patients younger than 18 months of age evaluated at Montreal Children’s Hospital between 1998 and 2004 who were found to have BESS and a concomitant subdural hematoma on imaging. NAT was ruled out in every case.
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