Fulminant-type Infantile Acute Subdural Hematoma: Pre- and Post-operative Neuroimaging Analysis

Background: An acute subdural hematoma (ASDH) in an infant without external signs of head trauma is diagnosed as shaken baby syndrome (SBS) in the United States or as an infantile acute subdural hematoma (IASDH) due to minor head trauma in Japan. The present case report analyzes the pre- and postoperative neuroimaging findings of fulminant-type IASDH and demonstrates that this condition can resolve fully with prompt surgery. Case description: A 9-month-old, male infant fell at home while trying to stand up by holding on to a sofa. He and struck his occipital region on a mat. and He began crying. Soon thereafter he and displayed signs of altered consciousness status and seizure-like activity. He was taken to an emergency room by ambulance where head computed tomography (CT) revealed a left-sided, holohemispheric, subdural collection with a remarkable midline shift. The patient’s conscious status deteriorated rapidly, requiring an emergency craniotomy. Intraoperatively, bloody fluid gushed out, and a partially clotted hematoma was removed. The origin of the hemorrhage was unable to be determined. His postoperative course was favorable without any neurological deficits. Fundoscopic examination revealed a left-sided retinal hemorrhage. Postoperative CT on day 1 visualized a thin line indicative of a subdural hematoma (SDH) with resolution of the mass effect. Magnetic resolution imaging (MRI) on day 16 revealed a thin, tapering SDH. CT on day 34 found a tiny, film-like hemorrhage. The patient was followed up on an outpatient basis for more than two years but did not present any neurological abnormalities. Discussion & Conclusion: The present case is invaluable because it demonstrates that the outcome of emergency surgery and the ensuing recovery of fulminant-type IASDH can be favorable in the absence of a cerebral parenchymal injury. Particularly relevant here is the thin, film-like image observed after evacuation of the ASDH, which likely indicated the localization of the hemorrhage in the dural border cell layer (DBCL). Based on the serial neuroimaging analysis, the fulminant-type IASDH was considered secondary to the spread of the hemorrhage in the BDCL into the subdural compartment.