Masatoshi Ozawa

Clinical and Pathological Studies on Posterior Fossa Subdural Hematoma of the Newborn

Subdural hematoma of the posterior fossa is infrequent, but lethal in the newborn. We have already reported the successful surgical treatment of a case of posterior fossa subdural hematoma. The patient is now 27 months old and is still shunt dependent. Her body development is normal and her development quotient is 89. Since then, we experienced two other cases, but they died. The second case was a 6-hour-old male infant who was born with breech presentaion and 2nd degree of asphyxia was seen. Immediately after the birth, oxygen was administered to the patient who was in a syncope state. In 60 minutes, respiratory like movements were observed. One hour and a half later, grunting and twitching of the eyelids occurred. The patient died 26 hours postpartum. The third case was a 42-day-old male infant who was delivered by cesarean section. Two days before admission to the hospital vomiting, apneic spells and convulsions occurred. Subdural hematomas were present in the left frontal region and in the posterior fossa. He died 5 days after the operation. In the past 17 years, 134 autopsies with intracranial hemorrhages were carried out within 14 days after birth at the Dept. of Pathology and 18 cases of the posterior fossa subdural hematoma were discovered. Twenty one cases consist of 3 treated cases and 18 untreated cases, discovered at autopsy. Labour patterns are classified as follows; natural delivery 10, breech 5, forceps or vacuum 4 and cesarean section 2. From the standpoint of maturity, 10 cases are mature and 11 cases are premature infants. One of the clinical findings at admission is increased tension of the anterior fontanelle which is the foremost objective sign in the posterior fossa subdural hematoma of the newborn. Clinical diagnosis prior to autopsies were pulmonary hemorrhage 6, IRDS 4, intracranial hemorrhage 3 and others in the untreated cases. The average period of survival of 19 cases excluding case 1 and case 3 was 4.5 days and the range was 0 to 10 days. Case 3 was thought to be exceptional, because initial symptoms occured 40 days postpartum instead of within 15 days after birth. As for the hemorrhage site, these 21 cases can be divided into 4 groups. Group I : the hematoma is present mainly under the base of the brain and surrounding the brainstem. 10 cases belong to group 1. Group 1 cases are often complicated by serious supratentorial hemorrhages. In some cases, the whole brain was seen floating in the blood. Group II: the hematoma is present between the tentorium cerebelli and the superior surface of the cerebellum. Seven cases belong to this group. Group III: the hematoma is present under the lower surface of the cerebellum. Three cases belong to this group. Group IV: the hematoma is present on all the circumference of the cerebellum. One case belongs to this group. In this report, we want to emphasize that as far as the clinical diagnosis is concerned, ventriculography is important as a rule when the coronal subdural taps are negative and that reflux brachial angiography is needed lest the presence of hematoma in other sites should be overlooked.