Subdural Haemorrhage in Infant with Macrocephaly.
Abstract
Background : Subdural haemorrhage (SDH) are often seen after a traumatic events fall, accident or a result of a physical abuse. Here we present a case of subdural haemorrhage in an infant with macrocephaly without any preceding history of trauma, fall, accident or physical abuse.
Case presentation : A 6 month old child with macrocephaly was presented to our department with history of fever, multiple episodes of vomiting and sleepiness. Was initially diagnosed with meningitis and subsequently in the ward developed seizures and neurological deficit which led to CT brain imaging and bilateral SDH of varying ages with mass effect was reported. No history of trauma prior, and possibility of physical abuse has been ruled out.
Discussion : Child with macrocephaly or a rapidly enlarging head circumference > 95th percentile for age are commonly associated with benign enlargement of subarachnoid spaces (BESS). The underlying theory is that, stretching of the bridging subdural veins due to enlargement of the cerebrospinal fluid (CSF) spaces predispose to developing SDH. SDH in children with BESS may occur spontaneously or as a result of minor trauma.
Conclusion : BESS is a condition that does not require treatment, however it is very common to be present in infants with macrocephaly. The association of increasing degrees of BESS with increasing prevalence of subdural collection support the concept of an anatomical predisposition to SDH among infants with macrocephaly.
