Recognised causes of subdural haemorrhage in infants and young children
| Cause of SDH | Comment |
|---|---|
| Intentional injury | |
| Shaken baby syndrome | The commonest cause of SDH1 |
| SDH is commonly associated with other injuries and retinal haemorrhages. | |
| However shaken baby syndrome can cause isolated SDH or isolated retinal haemorrhages | |
| Non-intentional injury27 | |
| Major trauma, e.g road traffic accident, serious falls | Minor household falls rarely cause SDH. |
| SDH has been described in more serious falls and in whiplash injury27 | |
| Retinal haemorrhages are only associated with severe accidental injury7 | |
| Neurosurgical complications | SDH commonly reported as a postoperative complication of neurosurgery |
| Perinatal | |
| Fetal28 | SDH infrequently reported on fetal ultrasound scans |
| Traumatic labour29 | SDH can follow traumatic delivery and be associated with retinal haemorrhage |
| Cranial malformations | |
| Aneurysms30 | Spontaneous bleeding from vascular malformations |
| Arachnoid cysts31 | Less serious trauma can result in SDH when arachnoid cyst is present |
| Both are unlikely to be associated with retinal haemorrhages unless intracranial pressure is raised | |
| Cerebral infections | |
| Meningitis3233 | Postinfective subdural effusions are seen. |
| These can be associated with retinal haemorrhage7 | |
| Coagulation and haematological disorders | |
| Leukaemia34 | Diagnosis will be excluded on coagulation and haematological investigations. All may be associated with retinal haemorrhages7 |
| Sickle cell anaemia35 | |
| Disseminated intravascular coagulation | |
| Haemophilia36 | |
| von Willibrand's disease | |
| Haemorrhagic disease of the newborn37 | |
| Idiopathic thrombocytopenia purpura38 | |
| Metabolic disorders | |
| Glutaric aciduria16 | Associated with widening of subdural space that can result in SDH due to stretching and rupture of subdural vessels |
| Galactosaemia39 | Case reports describe associated retinal haemorrhages in both conditions1640 |
| Biochemical disorder | |
| Hypernatraemia141 | SDH described in association with salt poisoning, hypernatraemic dehydration |
| Hypernatraemia may also be a complication of the intracranial trauma |