Neonatal Posterior Fossa Subdural Hematoma

Abstract

Hemorrhage into the posterior fossa is a rare neurosurgical emergency in neonates. CT scanning is diagnostic. Blood layering under the apex of the tentorium cerebelli, however, may resemble a dilated vascular structure, and the rigidity of the pressured tentorium may prevent upward transmission of increased intracranial pressure, resulting in a soft fontanelle.

Organizing posterior fossa hematomas simulating developmental cysts on prenatal imaging: report of 3 cases.

“…Posterior fossa hematomas in neonates are rare but well described. 3,8,9 They are thought to reflect stress on the tentorium cerebelli as the fetal head undergoes deformation during vaginal delivery, 1 and, in fact, tentorial tears can sometimes be shown at autopsy. 2 Uncommonly, posterior fossa subdural hematomas arise spontaneously in utero 7 and in neonates born by cesarean delivery, 3 suggesting an alternative cause in some instances.…”

“…3,8,9 They are thought to reflect stress on the tentorium cerebelli as the fetal head undergoes deformation during vaginal delivery, 1 and, in fact, tentorial tears can sometimes be shown at autopsy. 2 Uncommonly, posterior fossa subdural hematomas arise spontaneously in utero 7 and in neonates born by cesarean delivery, 3 suggesting an alternative cause in some instances. Factors associated with prenatal or neonatal subdural hemorrhage at any intracranial site include abdominal trauma [10][11][12] and maternal coagulopathy.…”

“…Surgical evacuation is required in some infants. 1,3,4,15,[17][18][19][20][21][22][23][24][25] Occasionally, shunt placement is necessary for relief of hydrocephalus because of either compression on the aqueduct by the hematoma or the presence of intraventricular blood inciting aqueductal stenosis. 18,[20][21][22] Despite timely treatment, many surviving children have developmental delays and spasticity (cerebral palsy).…”

“…1,2 A few cases of posterior fossa subdural or intradural hematomas have been reported in stillbirths and in infants born by cesarean delivery, indicating that nontraumatic mechanisms of posterior fossa hemorrhage must also exist. 3 Rarely, subdural hematomas have been documented in fetuses by prenatal ultrasonography, [4][5][6][7] most associated with trauma (e.g., motor vehicle accidents or assaults) and occurring over the cerebral hemispheres. In this report, we document the unusual imaging features in 3 fetuses with subdural hematomas in the posterior fossa, attached to the tentorium cerebelli.…”

Comprehensive Clinical and Neuroimaging Review of Posterior Fossa Hemorrhage in Preterm and Term Newborns

“…The diagnosis of PFH neonatally is now performed easily and accurately by CT and MRI. [50][51][52][53][54] Before the introduction of CT scanning, PFH was usually identified only at autopsy. 55,56 The ability of precise localization of PFH in both the coronal and sagittal planes favors the usage of CT.…”