Posterior fossa subdural hematoma

Overview

Posterior fossa subdural hematoma (PFSDH), also known as subdural hematomas of the posterior fossa is very rare and most cases are related to head injury. When it happenes in a serious and rare condition in newborns, generally occurring after difficult deliveries. The influence of anticoagulation in the cases of spontaneous development is well known. Although diagnosis is easily achieved by CT scan, atypical form may lead to the wrong diagnosis of cerebellar hematoma.

 

Symptoms

Causes

Subdural hematomas rarely occur in the posterior fossa and the estimated incidence is less than 0.6% among intracranial subdural hematomas. Regarding its origin, head injury is the most frequent cause, and 30 to 50% of these traumatic cases show associated occipital skull fracture. Nontraumatic causes include rupture of an aneurysm or an arteriovenous malformation in the posterior fossa. 

Treatment

In neonates with a PFSDH, surgery can be safely performed in those with clinical and radiological signs of brainstem compression or hydrocephalus. A small number of neonates require a ventriculo-peritoneal shunt in the long term. Initial aggressive resuscitation should be performed even in cases of initial severe brainstem dysfunction because of the good long-term neurological outcome.

Source: The Management of Birth-Related Posterior Fossa Hematomas in Neonates. Neurosurgery, May 2013,72:5,755–762