Intrauterine Spontaneous Subdural Hematoma with Hydrocephalus

Abstract

Abstract Subdural hematoma in newborn baby is associated with history of maternal trauma, complicated vaginal delivery, instrumental delivery, foetal / maternal thrombocytopenia, coagulopathy, hepatic disease, infection or using drugs during the pregnancy; but in the absence of the above, intrauterine subdural hematoma is a rare event. We present a newborn delivered to a healthy mother at 38 weeks by elective caesarean section after he had been diagnosed with macrocephaly by routine obstetric growth scan ultrasound at 35 weeks of gestational age. The baby’s APGAR score was 4 at 1 minute, he was pale, his fontanel was tense and his Occipitofrontal circumference (OFC) was 46 cm, therefore, he was intubated immediately and transferred to Neonatal Intensive Care Unit (NICU). Brain Computed tomography (CT –scan) revealed huge right sided subacute subdural hematoma that was almost occupying the entire right hemicranial space and severely compressing the underlying brain tissue. In addition, there was marked dilatation of the left lateral ventricle with blood clots at the occipital horn. Subdural hematoma was evacuated by two burr holes surgery, followed by repeated subdural tap. Intraventricular haemorrhage treated by repeated ventricular tap until Cerebrospinal Fluid (CSF) became clear, then ventriculoperitoneal shunt surgery was done for him. Keywords: Subdural hematoma, Newborn, Hydrocephalus, Burr hole, Shunt surgery.