Samuel Stafrace (Raigmore Hospital/Inverness/Scotland), J. Miller (Raigmore Hospital/Inverness/Scotland), H. Shannon (Raigmore Hospital/Inverness/Scotland)  

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2 Weeks  

Female  

Head-Brain and brain nerves  

physical  

Normal term baby.
Difficult ventouse delivery.
Low Apgar scores.  

Subdural haematoma- collection of blood in potential space between pia-arachnoid and dura.Crosses suture lines. Limited by dural reflections. It is argued in the literatiure that neonatal subdural is not always indicative of birth trauma.

Cephalhaematoma - Incidence: 2.5%. Increased incidence with vacuum extraction - up to 23%. Represents a subperiosteal collection of blood. Rarely complicated by infection in relation with aspiration, scalp electrode or general sepsis.  

<- view CT 1

CT 1: demonstrates a crescentic extracranial hyperattenuated collection to the right of the skull vault which does not cross sutures.






<- view CT 2

CT 2: demonstrates a crescentic hyperattenuated collection in the posterior fossa.






<- view CT 3

CT 3: shows extention of the infratentorial collection above the tentorium adjacent to the posterior falx.






<- view MRI 1

MRI 1: - Sagittal T1 image showing a crescentic high signal collection in the posterior fossa and mixed signal in the extracranial collection.






<- view MRI 2

MRI 2: - Axial T1 (GRE) image showing a crescentic high signal collection in the posterior fossa.





 

Expert's opinion  

Extracranial collection - Caput succedaneum; oedema not blood and crosses suture lines.

Posterior fossa collection-
Extradural which would have an elliptical configuration and does not cross sutures.
Subarachnoid blood - would be seen between the sulci. Both unlikely in this case.
 

Subdural haematoma - Majority treated with expectant therapy. Depends on size and clinical condition.

Cephalhaematoma - Conservative treatment. Surgical if ossified and causing skull deformities.  

Good example of two different pathologies related to birth.

Shows different signal in both haematomas on MRI.  

N/A  

1. Medline:
Dahnert Wolfgang
Radiology Review Manual 5th edition
Lippincott Williams and Wilkins.

2. Medline:
Chamnanvanakij S, Rollins N, Perlman JM
Subdural hematoma in term infants.
Pediatr Neurol. 2002 Apr;26(4):301-4

3. Medline:
Chen MH, Yang JC, Huang JS, Chen MH
MRI features of an infected cephalhaematoma in a neonate.
J Clin Neurosci. 2006 Oct;13(8):849-52. Epub 2006 Aug 22

4. Medline:
Johanson RB, Menon BK
Vacuum extraction versus forceps for assisted vaginal delivery.
Cochrane Database Syst Rev. 2000;(2):CD000224

5. Medline:
Thacker KE, Lim T, Drew JH
Cephalhaematoma: a 10-year review
Aust N Z J Obstet Gynaecol. 1987 Aug;27(3):
210-2

6. Medline:
Chung HY, Chung JY, Lee DG, Yang JD, Baik BS, Hwang SG, Cho BC.
Surgical treatment of ossified cephalhematoma.
J Craniofac Surg. 2004 Sep;15(5):774-9  

birth related subdural hematoma, posterior fossa bleed, cephalhaematoma, cephalhematoma, extracranial bleed, child, childhood, pediatric radiology  

Samuel Stafrace, J Miller, H Shannon. Posterior fossa subdural hematoma and Cephalhematoma. PedRad [serial online] vol 6, no. 11.
URL: www.PedRad.info/?search=20061112110821