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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- 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.
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: Sep 18, 2017.References
- Proctor MB. Neurosurgical aspects of non-accidental trauma in children. In: Neurological Surgery Principles and Practice, Loftus B (Ed), Lippincott Williams and Wilkins, Philadelphia 2003. p.1065.
- Whitby EH, Griffiths PD, Rutter S, et al. Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 2004; 363:846.
- Jayawant S, Rawlinson A, Gibbon F, et al. Subdural haemorrhages in infants: population based study. BMJ 1998; 317:1558.
- Hobbs C, Childs AM, Wynne J, et al. Subdural haematoma and effusion in infancy: an epidemiological study. Arch Dis Child 2005; 90:952.
- Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta 2006.
- Haines DE, Harkey HL, al-Mefty O. The "subdural" space: a new look at an outdated concept. Neurosurgery 1993; 32:111.
- Yamashima T, Friede RL. Why do bridging veins rupture into the virtual subdural space? J Neurol Neurosurg Psychiatry 1984; 47:121.
- Besenski N. Traumatic injuries: imaging of head injuries. Eur Radiol 2002; 12:1237.
- Duhaime AC, Gennarelli TA, Thibault LE, et al. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 1987; 66:409.
- Victor M, Ropper A. Craniocerebral trauma. In: Adams and Victor's Principles of Neurology, 7th ed, Victor M, Ropper A (Eds), McGraw-Hill, New York 2001. p.925.
- Kim BS, Jallo GI, Kothbauer K, Abbott IR. Chronic subdural hematoma as a complication of endoscopic third ventriculostomy. Surg Neurol 2004; 62:64.
- Allen CH, Ward JD. An evidence-based approach to management of increased intracranial pressure. Crit Care Clin 1998; 14:485.
- Monro A. Observations on the Structure and Functions of the Nervous System, Creech and Johnson, Edinburgh 1783.
- Kellie, G . An account of the appearances observed in the dissection of two of the individuals presumed to have perished in the storm of the third, and whose bodies were discovered in the vicinity of Leith on the morning of the 4th November 1821; with some reflections on the pathology of the brain. Trans Med Chir Soc (Edinburgh) 1821- 1832; 1:84.
- Steele DW. Neurosurgical emergencies, nontraumatic. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1717.
- Poss WB, Brockmeyer DL, Clay B, Dean JM. Pathophysiology and management of the intracranial vault. In: Textbook of Pediatric Intensive Care, Rogers MC (Ed), Williams & Wilkins, Baltimore 1996. p.645.
- Greenes DS. Neurotrauma. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1361.
- Durham SR, Duhaime AC. Basic science; maturation-dependent response of the immature brain to experimental subdural hematoma. J Neurotrauma 2007; 24:5.
- Carmel PW, Albright AL, Adelson PD, et al. Incidence and management of subdural hematoma/hygroma with variable- and fixed-pressure differential valves: a randomized, controlled study of programmable compared with conventional valves. Neurosurg Focus 1999; 7:e7.
- Swift DM, McBride L. Chronic subdural hematoma in children. Neurosurg Clin N Am 2000; 11:439.
- Vinchon M, Joriot S, Jissendi-Tchofo P, Dhellemmes P. Postmeningitis subdural fluid collection in infants: changing pattern and indications for surgery. J Neurosurg 2006; 104:383.
- McNeely PD, Atkinson JD, Saigal G, et al. Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. AJNR Am J Neuroradiol 2006; 27:1725.
- Pittman T. Significance of a subdural hematoma in a child with external hydrocephalus. Pediatr Neurosurg 2003; 39:57.
- Sasaki-Adams D, Kulkarni A, Rutka J, et al. Neurosurgical implications of osteogenesis imperfecta in children. Report of 4 cases. J Neurosurg Pediatr 2008; 1:229.
- Bishop FS, Liu JK, McCall TD, Brockmeyer DL. Glutaric aciduria type 1 presenting as bilateral subdural hematomas mimicking nonaccidental trauma. Case report and review of the literature. J Neurosurg 2007; 106:222.
- Donaldson JW, Edwards-Brown M, Luerssen TG. Arachnoid cyst rupture with concurrent subdural hygroma. Pediatr Neurosurg 2000; 32:137.
- Mori K, Yamamoto T, Horinaka N, Maeda M. Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma 2002; 19:1017.
- Parsch CS, Krauss J, Hofmann E, et al. Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 1997; 40:483.
- Hopkin J, Mamourian A, Lollis S, Duhaime T. The next extreme sport? Subdural haematoma in a patient with arachnoid cyst after head shaking competition. Br J Neurosurg 2006; 20:111.
- Sajanti J, Majamaa K. High concentrations of procollagen propeptides in chronic subdural haematoma and effusion. J Neurol Neurosurg Psychiatry 2003; 74:522.
- Mayer S, Rowland L. Head injury. In: Merritt's Neurology, Rowland L (Ed), Lippincott Williams & Wilkins, Philadelphia 2000. p.401.
- Labadie EL, Glover D. Physiopathogenesis of subdural hematomas. Part 1: Histological and biochemical comparisons of subcutaneous hematoma in rats with subdural hematoma in man. J Neurosurg 1976; 45:382.
- Lee KS. The pathogenesis and clinical significance of traumatic subdural hygroma. Brain Inj 1998; 12:595.
- 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