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Infantile acute subdural hematoma

Clinical analysis of 26 cases

Nobuhiko Aoki and Hideaki Masuzawa

✓ Twenty-six cases of infantile acute subdural hematoma treated between 1972 and 1983 were reviewed. The series was limited to infants with acute subdural hematoma apparently due to minor head trauma without loss of consciousness, and not associated with cerebral contusion. Twenty-three of the patients were boys, and three were girls, showing a clear male predominance. The patients ranged in age between 3 and 13 months, with an average age of 8.1 months, the majority of patients being between 7 and 10 months old. Most of the patients were brought to the hospital because of generalized tonic convulsion which developed soon after minor head trauma, and all patients had retinal and preretinal hemorrhage. The cases were graded into mild, intermediate, and fulminant types, mainly on the basis of the level of consciousness and motor weakness. Treatment for fulminant cases was emergency craniotomy, and that for mild cases was subdural tapping alone. For intermediate cases, craniotomy or subdural tapping was selected according to the contents of the hematoma. The follow-up results included death in two cases, mild physical retardation in one case, and epilepsy in one case. The remaining 23 patients showed normal development.

The relationship between computerized tomography (CT) findings and clinical grading was analyzed. Because some mild and intermediate cases could be missed on CT, the importance of noting the characteristic clinical course and of funduscopic examination is stressed.

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Unilateral subdural-peritoneal shunting for bilateral chronic subdural hematomas in infancy

Report of three cases

Nobuhiko Aoki, Hiroshi Mizutani, and Hideaki Masuzawa

✓ The authors present the cases of three infants with bilateral chronic subdural hematomas (SDH's) (effusions). Communication between the hematoma cavities was confirmed by an injection of air or metrizamide into one of the cavities. In all three cases, both SDH's (effusions) were successfully treated by placement of a unilateral subdural-peritoneal shunt without any untoward consequences. It is stressed that the cavities of bilateral chronic SDH's (effusions) may communicate, and that in such cases unilateral subdural-peritoneal shunting is sufficient to eradicate the SDH's on both sides. In addition, subdural fluid, even with a high protein concentration, may be successfully eliminated by an internal shunt using a shunt tube with a large internal caliber and a low-pressure valve.

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Subdural Hematomas in Infants

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Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Séquard syndrome

Case report

Hideaki Masuzawa, Hitoshi Nakayama, Nobuyuki Shitara, and Takeyo Suzuki

✓ This is a report of a patient who developed sharp intercostal pain and Brown-Séquard syndrome. Displacement of the spinal cord toward an extradural mass was noted at the T4–5 vertebral level on iophendylate myelography and metrizamide computerized tomography myelography. Multiple meningeal diverticular lesions of congenital origin were also found. Surgical correction of the spinal cord, which had herniated into a laterally located extradural arachnoid cyst and become incarcerated, resulted in a complete neurological recovery.