Abstract
A case of infantile bilateral chronic subdural hematoma following acute traumatic epidural hematoma is reported.
This male infant had head trauma when 3 months old without initial lost of consciousness. He vomited at night and his lips, face and body turned pale the next morning. Neurological examinations on May 10, 1978, the next day after the trauma, revealed tense, bulging anterior fontanel, conjugate deviation to the left and slight right hemiparesis. Laboratory test data showed marked anemia. CT scans showed midline deviation to the right, a round high density area just beneath the calvarium in the left parietal region with a small low density area within it, and also a slightly high density area over the bifrontal region. Operation disclosed about 170 g of epidural hematoma caused by linear fracture of the posterior branch of middle meningeal artery. Postoperative CT scans showed subdural fluid collection in the bilateral fronto-temporal regions without shift of midline structures. He was discharged with slight right upper monoparesis 15 days after surgery.
In mid-July, he once suffered fever, vomited and showed pallor of face in the morning. Neurological examination on August 10, 1978 revealed slight right upper monoparesis and slightly enlarged head circumferance. CT scans showed high density over the bilateral fronto-temporal regions, especially on the left side with shift of midline structures. Subdural hematomas on the left and right side of 70 ml and 30 ml, respectively, were evacuated through burr holes. Histological findings of the outer membrane of hematomas showed sinusoidal channel layer in the outer layer and moderately fibrous tissue proliferation with old hemorrhages in the inner layer.
The process leading to the development of chronic subdural hematoma in this case is considered as follows: 1) neo-membrane with marked proliferation of capillaries and fibrous tissue began to form during a certain period after head trauma in response to subdural fluid which consisted of a mixture of blood and cerebrospinal fluid; 2) this process was enhanced by the sudden decrease of intracranial pressure after removal of the epidural hematoma; and 3) repeated hemorrhages into the cavity from this neo-membrane may have resulted in causing chronic subdural hematoma.
