Acute subdural hematoma in infancy and childhood

Abstract

27 cases of acute posttraumatic subdural hematomas diagnosed and treated by the authors from 1968 to 1972 are presented. Five were newborns, 18 were infants, and three were toddlers. The youngest patient was 38 h and the oldest 5 years old. The most common age was between 1 and 3 months. Falls were the most frequent cause of injury, parental or familial abuse was next. A correlative analysis of the different clinical pictures in each of these age groups is made. We stressed that the presence of hemorrhages in the fundi, and convulsions, in the infant who has suffered a head injury, are indications for contrast studies. A critical analysis of subdural taps, as a method of diagnosis and treatment, is made: we seriously doubt that subdural taps are of any real value in the clinical management of a child with acute head injury. Comparative analysis of the surgical treatment and results is made. Twelve patients were treated with repeated subdural taps, 15 with craniotomy. Of the former group, 41.6% developed a chronic subdural whereas only 13% of the latter group developed this complication. Five out of the 27 patients died. Comparative psychological evaluation of these two groups, surgical and nonsurgical, is presented. In the surgical group 72.7% had an IQ over 80 and in the nonsurgical group only 25% had an IQ over 80. A correlative analysis of the clinical picture, method of diagnosis, surgical result, and psychological tests are analyzed.