Steinbok P, Haw C S, Cochrane D D, Kestle J R
Division of Neurosurgery, B.C.'s Children's Hospital, Vancouver, Canada.
Pediatr Neurosurg. 1995;23(4):206-15. doi: 10.1159/000120960.
Acute subdural hematomas in the full-term neonate are usually thought to be a manifestation of birth trauma. Most commonly, these hematomas are associated with a tentorial tear, and less frequently are secondary to damage to the occipital sinus accompanying occipital osteodiastasis, or to rupture of bridging superficial cerebral convexity veins. We report 6 cases of acute subdural hematoma associated with cerebral infarction (SDH/CI) in term neonates, an entity which has not been well-documented previously. This combination accounted for half the cases of neonatal acute subdural hematomas referred to a pediatric neurosurgical service. All children presented within 72 h of birth, usually after an uneventful delivery, and typically with seizures (5/6), apneic spells (3/6) and a full or bulging fontanel (5/6). Although the patients were referred to the neurosurgical servive for management of a convexity subdural hematoma, the CT scans showed a large associated cerebral infarct, which was hemorrhagic in 5 of the 6 cases, most commonly in the distribution of the middle cerebral artery. Craniotomy was performed in 4 patients, needle aspiration of the subdural hematoma in 1, and no surgical intervention in 1. The outcome in 3 patients, who have been followed for more than 1 year, has been good, with some mild focal neurologic deficits, but no seizure activity. The pathogenesis of this entity is unclear, but the acute subdural hematoma in these cases is probably secondary to the cerebral infarction. Recognition of SDH/CI as a specific entity in term neonates has significant management and possibly medicolegal implications.
足月儿急性硬膜下血肿通常被认为是产伤的一种表现。最常见的是，这些血肿与小脑幕撕裂有关，较少见的是继发于枕骨骨分离伴枕窦损伤或大脑凸面桥静脉破裂。我们报告了6例足月儿急性硬膜下血肿合并脑梗死（SDH/CI）的病例，这一情况以前尚无充分的文献记载。这种情况占转诊至小儿神经外科服务的新生儿急性硬膜下血肿病例的一半。所有患儿均在出生后72小时内就诊，通常在顺产之后，典型表现为惊厥（5/6）、呼吸暂停发作（3/6）和囟门饱满或膨隆（5/6）。尽管这些患儿因凸面硬膜下血肿被转诊至神经外科，但CT扫描显示伴有大面积脑梗死，6例中有5例为出血性梗死，最常见于大脑中动脉供血区。4例患儿接受了开颅手术，1例进行了硬膜下血肿穿刺抽吸，1例未进行手术干预。3例随访超过1年的患儿预后良好，有一些轻度局灶性神经功能缺损，但无癫痫发作。这种情况的发病机制尚不清楚，但这些病例中的急性硬膜下血肿可能继发于脑梗死。认识到SDH/CI是足月儿中的一种特定情况具有重要的管理意义，可能还具有法医学意义。
