Rousslang LK, Rooks EA, Meldrum JT, Hooten KG, Wood JR. Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling: A case report. World J Radiol 2021; 13(9): 307-313 [PMID: 34630916 DOI: 10.4329/wjr.v13.i9.307]
Corresponding Author of This Article
Lee K Rousslang, MD, Doctor, Department of Radiology, Tripler Army Medical Center, 1 Jarrett White Rd, Medical Center, HI 96859, United States. lee.k.rousslang.civ@mail.mil
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Sep 28, 2021; 13(9): 307-313 Published online Sep 28, 2021. doi: 10.4329/wjr.v13.i9.307
Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling: A case report
Lee K Rousslang, Elizabeth A Rooks, Jaren T Meldrum, Kristopher G Hooten, Jonathan R Wood
Lee K Rousslang, Jonathan R Wood, Department of Radiology, Tripler Army Medical Center, Medical Center, HI 96859, United States
Elizabeth A Rooks, Department of Neuroscience, Duke University, Durham, NC 27708, United States
Jaren T Meldrum, Department of Radiology, Alaska Native Medical Center, Anchorage, AK 99508, United States
Kristopher G Hooten, Department of Neurosurgery, Tripler Army Medical Center, Medical Center, HI 96859, United States
Author contributions: Rousslang LK is the primary author; Rooks EA assisted by performing research background for the case and contributing portions of the writing; Meldrum JT assisted by providing primary edits and the initial radiological read; Hooten KG was the primary surgeon, and provided surgical insights into the case; Wood JR is the senior author who contributed final edits and portions of the unedited manuscript.
Informed consent statement: Informed written consent was obtained.
Conflict-of-interest statement: The authors have no financial, personal, or other vested interests in the information contained within this document.
CARE Checklist (2016) statement: The manuscript was checked according to the CARE Checklist (2016) statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lee K Rousslang, MD, Doctor, Department of Radiology, Tripler Army Medical Center, 1 Jarrett White Rd, Medical Center, HI 96859, United States. lee.k.rousslang.civ@mail.mil
Received: March 30, 2021 Peer-review started: March 30, 2021 First decision: June 7, 2021 Revised: June 22, 2021 Accepted: September 8, 2021 Article in press: September 8, 2021 Published online: September 28, 2021 Processing time: 179 Days and 22.4 Hours
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.
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.
