Spontaneous subdural haematoma in a neonate requiring urgent surgical evacuation
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CASE REPORT - PEDIATRIC NEUROSURGERY
Spontaneous subdural haematoma in a neonate requiring urgent surgical evacuation Phillip Correia Copley 1
&
Bethan Dean 2 & Angela L. Davidson 2 & Michael Jackson 3 & Drahoslav Sokol 1
Received: 15 June 2020 / Accepted: 3 September 2020 # The Author(s) 2020
Abstract We describe the unusual case of a clinically significant subdural haematoma without any underlying cause in a term baby delivered by an elective caesarean section, which required surgical evacuation. We review the literature and describe the presentation, investigation and management options in infants with this infrequent condition. Keywords Caesarean section . Craniotomy . Neonate . Spontaneous . Subdural haematoma
Abbreviations CS Caesarean section CSF Cerebrospinal fluid CT Computed tomography ICP Intracranial pressure GOS Glasgow outcome score MRI Magnetic resonance imaging VPS Ventriculoperitoneal shunt
Introduction The incidence of clinically apparent subdural haematomas in infants is estimated to be 24.1/100,000 [5]. Whilst subdural haematomas may occur due to peripartum trauma, occurrence after elective caesarean section (CS) and requirement for surgical intervention is extremely rare. This manuscript has not been presented or published previously, either in full or part. This article is part of the Topical Collection on Pediatric Neurosurgery * Phillip Correia Copley [email protected] 1
Department of Neurosurgery, Royal Infirmary of Edinburgh, 50 Little France Crescent, Edinburgh EH16 4TJ, UK
2
Department of Neonatology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK
3
Department of Pediatric Radiology, Royal Hospital for Sick Children, 9 Sciennes Rd, Edinburgh EH9 1LF, UK
Case report History and examination A female infant was born at 39 + 3 weeks by elective CS due to previous forceps delivery. Anomaly scan at 20 weeks was normal. There were no complications during pregnancy. Her birth weight was 2860 g and occipital frontal circumference 33 cm (both 9th–25th centiles). She required no resuscitation, had APGAR score of 9 1 + 9 5 and normal cord gases. Intramuscular vitamin K was given. She was reviewed at 18 h due to jaundice. Observations were normal, and examination demonstrated normal tone/reflexes and a soft fontanelle. Her total bilirubin was 80 umol/L (below threshold for phototherapy), haemoglobin 178 g/L and platelets 181 × 109/L. Upon routine newborn examination (30-hours post-delivery), the right pupil was noted to be dilated and non-reactive. The left was normal. The anterior fontanelle was full. There was no abnormality of facial/limb movements, and she was responsive to handling. Ultrasound demonstrated a right subdural haemorrhage (Fig. 1). Repeat bloods showed haemoglobin 182 g/L, platelets 182 × 109/L and a normal coagulation screen. Urgent transfer to the local neurosurgical centre was arranged. On admission, the only abnormal clinical findings were an isolated right third nerve palsy and a full fontanelle. Under usual circumstances, comp
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