title: Severe Acute Subdural Hemorrhage in a Patient With Glutaric Aciduria Type I After Minor Head Trauma: A Case Report.
abstract: Glutaric aciduria type I is a rare metabolic disorder caused by deficiency of glutaryl-coenzyme A dehydrogenase. Chronic subdural hematomas have been reported in glutaric aciduria type I and are considered as important differential diagnosis of nonaccidental head trauma. However, chronic subdural hematomas are usually thought to remain clinically silent in these patients. Here we report on a hitherto asymptomatic glutaric aciduria type I patient who developed severe, acute subdural hemorrhage after minor accidental head injury at age 23 months. Computed tomography confirmed significant mass effect on the brain necessitating decompressive hemicraniectomy. Subdural hemorrhage caused large hypoxic lesions of the cerebral cortex and subcortical regions resulting in spastic tetraplegia, dystonia, and loss of developmental milestones. This report emphasizes that acute subdural hemorrhage may be a life-threatening complication in glutaric aciduria type I patients after minor head trauma and should be considered in those patients presenting with neurologic deterioration after accidental head injury.
authors.affiliation: Division of Inherited Metabolic Diseases, Department of General Pediatrics, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Zielonka
authors.affiliation: Department of General Pediatrics, Children's Hospital Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Braun
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, Hospital Ludwigsburg, Ludwigsburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bengel
authors.affiliation: Division of Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Angelika
authors.initials: A
authors.lastname: Seitz
authors.affiliation: Division of Inherited Metabolic Diseases, Department of General Pediatrics, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kölker
authors.affiliation: Division of Inherited Metabolic Diseases, Department of General Pediatrics, University Hospital Heidelberg, Heidelberg, Germany nikolas.boy@med.uni-heidelberg.de.
authors.forename: Nikolas
authors.initials: N
authors.lastname: Boy
mesh_terms: D000592:Amino Acid Metabolism, Inborn Errors / Q000150:complications* / Q000209:etiology*; D001928:Brain Diseases, Metabolic / Q000150:complications* / Q000209:etiology*; D006259:Craniocerebral Trauma / Q000150:complications* / Q000601:surgery; D005260:Female; D050770:Glutaryl-CoA Dehydrogenase / Q000172:deficiency*; D006408:Hematoma, Subdural / Q000209:etiology*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging
chemical_list: D050770:Glutaryl-CoA Dehydrogenase
keywords: acute subdural hemorrhage; glutaric aciduria type 1; hemicraniectomy; minor accidental head trauma; tetraspasticity