Calcified Chronic Subdural Hematoma in a Young Child

Abstract

The patient, a male, had been born prematurely in October of 1980, at gestational week 32. His birthweight was 1, 820g. At 5 months of age he had a 5-minute episode of unconsciousness and was admitted to Sendai City Hospital. A computed tomography (CT) scan showed a very large, bilateral chronic subdural hematoma. The bilateral hematoma was evacuated and a right subdural peritoneal shunt was emplaced. In September of 1983 a left subdural peritoneal shunting procedure was carried out. However, 1 month later the latter shunt tube had to be removed because of infection. The hematoma then became calcified and gradually enlarged. In June of 1984 the organized, chronic subdural hematoma, which, together with the capsule, weighed 160g, was totally removed. The microscopic examination disclosed a relatively new hematoma within an old, organized hematoma. The postoperative course was uneventful and CT scans showed expansion of the brain.
There has been debate about whether or not a calcified chronic subdural hematoma should be removed. McLaurin reported that removal of such hematoma resulted in postoperative seizures and no improvement of mental retardation. The present case, however, showed improvement of CT findings and no postoperative seizures. The result suggests that, in infants and young children, calcified chronic subdural hematomas should be removed to prevent further brain atrophy and mental retardation.