Objective: Even after the advent of magnetic resonance imaging (MRI), few studies have focused on the clinical profiles and neuroimaging characteristics of acute subdural hematohygroma (ASDHy) in infants. The present study attempted to elucidate the pathogenesis of ASDHy by analyzing the clinical and neuroimaging findings of ASDHy. Materials & Methods: The subjects were 18 patients (eight males and ten females) younger than 2 years with ASDHy. Their median age at diagnosis was 3.8 months (range: 2-10 months), and 15 (83%) were younger than 4 months. Imaging studies found no evidence of any primary brain injury. Results: Five patients experienced a fall, and 13 (72%) had no history of head trauma. The presenting symptoms and signs were the acute onset of generalized convulsive seizures and or repeated vomiting. Retinal hemorrhage occurred in 14 patients (78%). The imaging studies revealed a large amount of bilateral, subdural fluid collection with an intensity higher than that of cerebrospinal fluid on MRI. Benign enlargement of the subarachnoid space (BESS) was found in 14 patients (78%), an enlarged sylvian fissure (LSF) was found in all the patients (100%), and greater, left-sided enlargement was evident in 16 patients (89%). Two patients underwent subdural drainage, and 16 patients (89%) were conservatively managed. All the patients had a favorable outcome. Conclusions: ASDHy is a self-limiting disorder associated with retinal hemorrhage and a benign clinical course. Most cases develop in early infancy. LSF presumably loosens the tight fixation of the temporal lobes at the middle cranial fossa, thereby increasing the rotational force of the brain even during mild or unnoticeable impacts. Increased cranio-cerebral disproportion, including BESS and LSF, is a structural vulnerability which can lead to ASDHy in early infancy.
| Published in | American Journal of Pediatrics (Volume 10, Issue 1) |
| DOI | 10.11648/j.ajp.20241001.15 |
| Page(s) | 26-33 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Acute Subdural Hematohygroma, Infantile Acute Subdural Hematoma, Shaken Baby Syndrome, Abusive Head Trauma, Benign Enlargement of Subarachnoid Space, Large Sylvian Fissure, Strucutural Vulnerability
| [1] | Wittschieber B, Karger D, PfeifFer H. Understanding Subdural Collections in Pediatric Abusive Head Trauma 2019 40: 388-395. |
| [2] | Aoki N. Extracerebral fluid collections in infancy: Role of magnetic resonance imaging in differentiation between subdural effusion and subarachnoid space enlargement J Neurosurg 1994 81: 20-23. |
| [3] | Lee HC, Chong S, Lee JY. Benign extracerebral fluid collection complicated by subdural hematoma and fluid collection: clinical characteristics and management. Childs Nerv Syst. 2018 34: 235–45. |
| [4] | Lee KS. The pathogenesis and clinical significance of traumatic subdural hygroma. Brain Inj. 1998 12: 595-603. |
| [5] | McNeely PD. Atkinson JD. Subdural Hematomas in Infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse AJNR Am J Neuroradiol. 2006 27: 1725–28. |
| [6] | Pedersen H. Measurement of the normal ventricular system and supratentorial subarachnoid space in children with computed tomography. Neuroradiology 1979 17: 231-237. |
| [7] | Fukuyαma Y, Miyao M, Ishizu T. Developmental changes in normal cranial measurements by computed tomography. Develop med child neurol. 1979 21: 425-432. |
| [8] | Hussain ZB, Hussain AD, Mitchell B. Extra-axial cerebrospinal fluid spaces in children with benign external hydrocephalus: A case control study. Neuroradiol J. 2017 30: 410-417. |
| [9] | Aoki N, Masuzawa H: Infantile acute subdural hematoma: Clinical analysis of 26 cases. J Neurosurg 1984 61: 273-280. |
| [10] | Aoki N Infantile acute subdural hematoma: caused by abuse or mild head trauma? Nerv Syst Children (Japanese) 2011 36: 326–330. |
| [11] | Aoki N: 2023 Clinical and neuroimaging characteristics in mild-type infantile acute subdural hematoma. Report of four cases Childs Nerv Syst 2023. https://doi.org/1007/s00381-023-06089-7 |
| [12] | Aoki N: Infantile Acute Subdural Hematoma with retinal hemorrhage caused by minor occipital impact witnessed by an ICU nurse: a case report. Pediatr Neurol Neurosci 2020 4(1): 47-50, 2020. |
| [13] | Shimoji K, Suehiro E, Matsuno A, Araki T. Abusive head trauma in Japan. Childs Nerv Syst 2022 Oct4. https://doi.org/10.1007/s00381-022-05692-44 |
| [14] | Aoki N. Chronic subdural hematoma in infancy. Clinical analysis of 30 cases in the CT era. J Neurosurg 1990 73: 201-205. |
| [15] | Papasian NC, Frim DM. Theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma Pediatr Neurosurg 2000 33: 188–93. |
| [16] | Scheller J, Wester K: Is external hydrocephalus a possible differential diagnosis when child abuse is suspected? Acta Neurochirurgica 2021. https://doi.org/10.1007/s00701-021-04786-3 |
| [17] | Tsubokawa T, Nakamura S, Satoh K. Effect of temporary subdural-peritoneal shunt on subdural effusion with subarachnoid effusion Childs Brain. 1984 11(1): 47-59. |
| [18] | Aoki N Unilateral subdural-peritoneal shunting for bilateral chronic subdural hematomas in infancy J Neurosurg 1985 63: 134-137. |
| [19] | Aoki N, Masuzawa H. Bilateral chronic subdural hematomas without communication between the hematoma cavities: treatment with unilateral subdural-peritoneal shunt. Neurosurgery 1988 22: 911-913. |
APA Style
Aoki, N. (2024). Infantile Acute Subdural Hematohygroma: A Clinical and Neuroimaging Analysis of 18 Cases. American Journal of Pediatrics, 10(1), 26-33. https://doi.org/10.11648/j.ajp.20241001.15
ACS Style
Aoki, N. Infantile Acute Subdural Hematohygroma: A Clinical and Neuroimaging Analysis of 18 Cases. Am. J. Pediatr. 2024, 10(1), 26-33. doi: 10.11648/j.ajp.20241001.15
AMA Style
Aoki N. Infantile Acute Subdural Hematohygroma: A Clinical and Neuroimaging Analysis of 18 Cases. Am J Pediatr. 2024;10(1):26-33. doi: 10.11648/j.ajp.20241001.15
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Download@article{10.11648/j.ajp.20241001.15,
author = {Nobuhiko Aoki},
title = {Infantile Acute Subdural Hematohygroma: A Clinical and Neuroimaging Analysis of 18 Cases},
journal = {American Journal of Pediatrics},
volume = {10},
number = {1},
pages = {26-33},
doi = {10.11648/j.ajp.20241001.15},
url = {https://doi.org/10.11648/j.ajp.20241001.15},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20241001.15},
abstract = {Objective: Even after the advent of magnetic resonance imaging (MRI), few studies have focused on the clinical profiles and neuroimaging characteristics of acute subdural hematohygroma (ASDHy) in infants. The present study attempted to elucidate the pathogenesis of ASDHy by analyzing the clinical and neuroimaging findings of ASDHy. Materials & Methods: The subjects were 18 patients (eight males and ten females) younger than 2 years with ASDHy. Their median age at diagnosis was 3.8 months (range: 2-10 months), and 15 (83%) were younger than 4 months. Imaging studies found no evidence of any primary brain injury. Results: Five patients experienced a fall, and 13 (72%) had no history of head trauma. The presenting symptoms and signs were the acute onset of generalized convulsive seizures and or repeated vomiting. Retinal hemorrhage occurred in 14 patients (78%). The imaging studies revealed a large amount of bilateral, subdural fluid collection with an intensity higher than that of cerebrospinal fluid on MRI. Benign enlargement of the subarachnoid space (BESS) was found in 14 patients (78%), an enlarged sylvian fissure (LSF) was found in all the patients (100%), and greater, left-sided enlargement was evident in 16 patients (89%). Two patients underwent subdural drainage, and 16 patients (89%) were conservatively managed. All the patients had a favorable outcome. Conclusions: ASDHy is a self-limiting disorder associated with retinal hemorrhage and a benign clinical course. Most cases develop in early infancy. LSF presumably loosens the tight fixation of the temporal lobes at the middle cranial fossa, thereby increasing the rotational force of the brain even during mild or unnoticeable impacts. Increased cranio-cerebral disproportion, including BESS and LSF, is a structural vulnerability which can lead to ASDHy in early infancy.
},
year = {2024}
}
TY - JOUR T1 - Infantile Acute Subdural Hematohygroma: A Clinical and Neuroimaging Analysis of 18 Cases AU - Nobuhiko Aoki Y1 - 2024/02/27 PY - 2024 N1 - https://doi.org/10.11648/j.ajp.20241001.15 DO - 10.11648/j.ajp.20241001.15 T2 - American Journal of Pediatrics JF - American Journal of Pediatrics JO - American Journal of Pediatrics SP - 26 EP - 33 PB - Science Publishing Group SN - 2472-0909 UR - https://doi.org/10.11648/j.ajp.20241001.15 AB - Objective: Even after the advent of magnetic resonance imaging (MRI), few studies have focused on the clinical profiles and neuroimaging characteristics of acute subdural hematohygroma (ASDHy) in infants. The present study attempted to elucidate the pathogenesis of ASDHy by analyzing the clinical and neuroimaging findings of ASDHy. Materials & Methods: The subjects were 18 patients (eight males and ten females) younger than 2 years with ASDHy. Their median age at diagnosis was 3.8 months (range: 2-10 months), and 15 (83%) were younger than 4 months. Imaging studies found no evidence of any primary brain injury. Results: Five patients experienced a fall, and 13 (72%) had no history of head trauma. The presenting symptoms and signs were the acute onset of generalized convulsive seizures and or repeated vomiting. Retinal hemorrhage occurred in 14 patients (78%). The imaging studies revealed a large amount of bilateral, subdural fluid collection with an intensity higher than that of cerebrospinal fluid on MRI. Benign enlargement of the subarachnoid space (BESS) was found in 14 patients (78%), an enlarged sylvian fissure (LSF) was found in all the patients (100%), and greater, left-sided enlargement was evident in 16 patients (89%). Two patients underwent subdural drainage, and 16 patients (89%) were conservatively managed. All the patients had a favorable outcome. Conclusions: ASDHy is a self-limiting disorder associated with retinal hemorrhage and a benign clinical course. Most cases develop in early infancy. LSF presumably loosens the tight fixation of the temporal lobes at the middle cranial fossa, thereby increasing the rotational force of the brain even during mild or unnoticeable impacts. Increased cranio-cerebral disproportion, including BESS and LSF, is a structural vulnerability which can lead to ASDHy in early infancy. VL - 10 IS - 1 ER -
Department of Neurosurgery, Bethlehem Garden Hospital, Tokyo, Japan; Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
