Outcome of Posterior Fossa Acute Subdural Hematoma in the Neonatal Period

Abstract

Of intracranial hemorrhage cases in the neonatal period, acute subdural hematomas in the posterior fossa caused by birth trauma are much less frequent than those located above the tentorium. Those located in the posterior fossa often show rapid deterioration and death. Six cases of this type of hematoma have been experienced in the last ten years. In all of these cases, onset occurred within seven days after birth, and five of them were difficult breech presentation cases and were delivered by such methods as forceps extraction. An overall neurological and computerized tomography (CT) scan examination indicated that the cases with good outcome showed signs and symptoms from 72 hours after delivery. Signs of intracranial hypertension were usually present in these cases, but signs of brain stem dysfunction were usually absent. In CT scans, localized high density areas were seen on the upper or lower surface of the cerebellar hemispheres. Fatal cases had an Apgar score of 5 points or less after delivery, and the symptoms occurred from immediately after, to six hours after delivery. The main symptoms in these cases were signs of brain stem dysfunction, such as respiratory disturbance and opisthotonus. In CT scans, there were high density areas in the basal cisterns around the brain stem, in the fourth ventricle, and in the vermis. As for the long term results, acute hydrocephalus affected the outcome of the posterior fossa hematomas in the neonate. CT scans generally provided useful information with respect to both diagnostic and therapeutic results. However, it is difficult to decide from the information of CT scans where the source or point of the bleeding is located. Because this disease occurs in a period when vital resistance is at its lowest, rapid and accurate diagnosis and adequate treatment are necessary. Therefore, a detailed investigation of neurological symptoms and repeated CT scans after abnormal delivery are essential.