title: Subdural hematoma in infants without accidental or nonaccidental injury: benign external hydrocephalus, a risk factor.
abstract: Benign external hydrocephalus (BEH) is considered a self-limiting condition in infants. Subdural hematoma (SDH) in infants without a history of trauma indicates nonaccidental injury (NAI). The authors studied whether SDH can complicate BEH without apparent trauma. Out of 45 children younger than 3 years with nontraumatic SDH, 9 (7 boys) with mean age 6 months had BEH as risk factor. Symptoms included increasing head size (8), fussiness, and irritability (3). Three had up-gaze restriction, 1 axial hypotonia, and 6 normal examination. Neuroimaging showed prominent extra-axial spaces; SDH was bilateral (6), subacute (5). Other etiological workup for SDH was negative except NAI in 1. Two required evacuation of SDH and subdural-peritoneal shunt; others managed conservatively. Development was normal in 8 on follow-up. On follow-up imaging of 8, SDH completely resolved in 3, markedly reduced in 3, and remained stable in 2. BEH is a risk factor for SDH in infants, thus not always benign.
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Partha S
authors.initials: PS
authors.lastname: Ghosh
authors.forename: Debabrata
authors.initials: D
authors.lastname: Ghosh
mesh_terms: D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications; D005260:Female; D006257:Head / Q000473:pathology; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000473:pathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D012886:Skull / Q000473:pathology; D013355:Subdural Space / Q000473:pathology*; D014057:Tomography, X-Ray Computed