Subdural hematomas may occur in children as a presenting symptom of vascular disease or vascular malformations.
Kawasaki disease is a multisystem disorder characterized by vasculitis of small and medium arteries. Neurologic complications, including meningoencephalitis, monocyte-predominant pleocytosis in the CSF, facial nerve palsy, seizures, hemiplegia, and sensorineural hearing loss have been reported to occur in 1.1% to 3.7% of affected children.103105 Two papers detailing seven cases of SDH in children as young as 6 months have been reported.106 107 The SDH in these cases was hypothesized to be caused by vasculitis of dural vessels. All cases reported to date have been in living subjects with no fatalities or for whom postmortem findings had been reported.
Intracranial arteriovenous malformations (AVM) and cavernous hemangioma are rare causes of neonatal intracranial haemorrhage.108 Neonatal subdural hemorrhage in association with AVM appears to have been reported only four times in the literature, although the principal author (G.R.) has dealt with a nonreported fatal case of SDH associated with a subtentorial meningeal AVM that initially was suspected to be a nonaccidental injury.
Cerebral aneurysms have a distinct male predominance (12:1), occurring most frequently in the distal middle cerebral artery distribution or the posterior circulation.109 They also have a higher incidence of large/giant aneurysms compared to adults. They are associated with head and birth trauma, infection (mycotic), fibro-muscular dysplasia, moyamoya disease, coarctation of the aorta, subacute bacterial endocarditis, collagen vascular disease, EDS, Marfan syndrome, syphilis, sickle cell anemia, and tuberous sclerosis. Rupture of the aneurysm may occur, resulting in intracranial hemorrhage. The case of a 7-month-old boy with SDH in association with a cluster of six basilar artery aneurysms was reported by Plunkett.110
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