Intracranial subdural hematoma in children: Epidemiology, anatomy, and pathophysiology
- Mark R Proctor, MD
Mark R Proctor, MD
- Associate Professor of Neurosurgery
- Harvard Medical School
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Subdural hematoma (SDH) forms when there is hemorrhage into the potential space between the dura and the arachnoid membranes. SDH in children differs significantly from SDH in adults because inflicted head injury is a common etiology, especially in pediatric patients under two years of age . In contrast to epidural hematoma (EDH), indications for operative management of SDH are less clear, and surgery is less likely to prevent morbidity and mortality. (See "Intracranial subdural hematoma in children: Clinical features, evaluation, and management" and "Intracranial epidural hematoma in children: Clinical features, diagnosis, and management".)
This review will discuss the epidemiology, anatomy, and pathophysiology of subdural hematoma in children. The clinical features, evaluation, and management of SDH in children and SDH in adults are discussed separately. (See "Intracranial subdural hematoma in children: Clinical features, evaluation, and management" and "Subdural hematoma in adults: Etiology, clinical features, and diagnosis" and "Subdural hematoma in adults: Prognosis and management".)
A rapid overview summarizes the important clinical features and initial management of SDH in children (table 1).
The etiology of SDH in children varies by age. SDH occurs most frequently in infants and toddlers less than two years of age.
Neonates — SDH may occur in up to 8 percent of term deliveries and appears to be associated with delivery by vacuum extraction or forceps . These hematomas are typically small and usually resolve within four weeks. They are usually asymptomatic.
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- Infants and toddlers
- Older children and adolescents
- Site of hemorrhage
- Subdural hematoma location
- Subdural and epidural hematoma anatomic comparison
- Blood vessel injury
- - Venous hemorrhage
- - Arterial hemorrhage
- - Dural traction
- Increased intracranial pressure (ICP)
- Type of injury
- - Severe head injury
- - Inflicted head injury (shaken baby syndrome)
- - Minor head injury
- Chronic subdural hematoma
- Subdural hygroma