Acute subdural hematoma post ventricular puncture in infants: A case report and review of the literature

INTRODUCTION AND IMPORTANCE: Acute subdural hematoma in infants is often due to non-accidental causes such as shaken baby syndrome or abuse. Occasionally a rupture of the cerebral bridge veins after ventricular puncture can lead to a subdural hematoma in infant. In this article we report the very first case of acute subdural hematoma after ventricular puncture of cerebrospinal fluid. CASE PRESENTATION: It is a 40-day-old male infant received at the pediatric emergency room for an infectious syndrome. An etiological assessment was carried out including a ventricular puncture of the cerebrospinal fluid. Two days after the puncture, the child develops a sudden alteration of consciousness during hospitalization, with a Blantyre coma score of 3/5. The CT scan performed showed a right subdural parieto-temporal hematoma associated with a right fronto-temporal parietal parenchymal hypodensity. A right temporo-parietal decompressive craniectomy was performed with evacuation of the acute subdural hematoma. Clinical improvement was obtained and the child was discharged after 3 weeks of hospitalization. CLINICAL DISCUSSION: Acute subdural hematoma post ventricular puncture is rarely reported in the literature. The mechanism would probably be a rupture of the bridging veins by sudden collapse of the parenchyma following rapid and excessive aspiration of cerebrospinal fluid. Its management is medico-surgical. This manuscript further demonstrates the importance of mastering the ventricular puncture technique which must be performed by an experienced neurosurgeon. CONCLUSION: The ventricular puncture remains a delicate gesture which must be carried out by a qualified neurosurgeon because of the risks of complications such as an acute subdural hematoma.