Traumatic brain injury in infants: the phenomenon of subdural hemorrhage with hemispheric hypodensity ("Big Black Brain").

Clinical and experimental studies of traumatic brain injury during immaturity have been far less numerous than those involving adults, and many questions remain about differences in injury responses among patients of different ages. This chapter reviews a distinctive injury pattern common in infants, the so-called "big black brain" response to acute subdural hematoma. The pathophysiology of this injury remains incompletely understood. Insights from both clinical observation and experimental studies have helped to clarify the probable causes of this injury pattern, which appears to require a combination of stressors during a particular period of maturation.