Abstract
The majority of subdural hemorrhages (SDH) are due to acceleration-deceleration forces associated with blunt head injury. So-called spontaneous subdural hemorrhages are described with coagulopathies, hemodialysis, hemophilia, and as extensions of hemorrhages due to other causes such as ruptured cerebral artery aneurysms. Recently, some have proposed that hypoxia causes subdural hemorrhage in infants and children.
Materials and Methods
Of 1,190 deaths of children younger than two years of age, we analyzed 366 that were due to asphyxial mechanisms, respiratory disease, prematurity, seizures, and perinatal hypoxic-ischemic encephalopathy. All underwent autopsy and 97% included a consultant neuropathology examination.
Results
Of the 366 decedents, hypoxic-ischemic encephalopathy (HIE) was diagnosed in 73 (20%) and evidence of subdural hemorrhage in 34 (9%). Of the 73 HIE deaths, 14 (19%) had SDH. Among these 14, 12 involved prematurity and/or perinatal HIE. Among the 20 fatalities with SDHs but without HIE, all were premature infants and/or had a SDH that pathologically pre-dated the putative hypoxic-ischemic event. Of the 34 SDHs, 24 were organized neomembranes and ten were organizing hemorrhages.
Discussion
SDHs that are not caused by acceleration-deceleration forces are routinely recognized in infants and children. Usually, they are clinically silent and may be associated with prematurity and perinatal birth events. At autopsy, subdural neomembranes frequently are incidental findings in infants and children who die from a variety of causes. This study does not support the theory that hypoxic-ischemic injury in infants and children causes subdural hemorrhage.
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