Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling: A case report

Abstract

BACKGROUND

Symptomatic neonatal subdural hematomas usually result from head trauma incurred during vaginal delivery, most commonly during instrument assistance. Symptomatic subdural hematomas are rare in C-section deliveries that were not preceded by assisted delivery techniques. Although the literature is inconclusive, another possible cause of subdural hematomas is therapeutic hypothermia.

CASE SUMMARY

We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischemic encephalopathy following an emergent C-section delivery for prolonged decelerations. Head ultrasound on day of life 3 demonstrated a rounded mass in the posterior fossa. A follow-up brain magnetic resonance imaging confirmed hypoxic ischemic encephalopathy and clarified the subdural hematomas in the posterior fossa causing mass effect and obstructive hydrocephalus.

CONCLUSION

The aim of this report is to highlight the rarity and importance of mass-like subdural hematomas causing obstructive hydrocephalus, particularly in the setting of hypoxic ischemic encephalopathy and therapeutic whole-body cooling.

Keywords: Hypoxic ischemic encephalopathy; Neonatal subdural hematoma; Therapeutic hypothermia; Case report

Core Tip: Screening head ultrasound during hypothermia protocols for hypoxic ischemic encephalopathy (HIE) warrant scrutiny for hemorrhage in unexpected locations. Symptomatic subdural hematomas warrant a high degree of clinical suspicion, particularly due to their rarity in children delivered by C-section. This report highlights the emerging association of HIE, therapeutic hypothermia, and perinatal intracranial hemorrhage. Prompt imaging and neurosurgical intervention may relieve hemorrhage induced obstructive hydrocephalus during therapeutic cooling with good neurological outcomes, preventing need for permanent cerebrospinal fluid diversion. Familiarity with the key imaging characteristics and clinical exam features of mass-like subdural hematomas can help the treatment team consider the diagnosis, and potentially enable a prompt recovery.