Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling: A case report

BACKGROUND: Symptomatic neonatal subdural hematomas usually result from head trauma incurred during vaginal delivery, most commonly during instrument assistance. Symptomatic subdural hematomas are rare in C-section deliveries that were not preceded by assisted delivery techniques. Although the literature is inconclusive, another possible cause of subdural hematomas is therapeutic hypothermia. CASE SUMMARY: We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischemic encephalopathy following an emergent C-section delivery for prolonged decelerations. Head ultrasound on day of life 3 demonstrated a rounded mass in the posterior fossa. A follow-up brain magnetic resonance imaging confirmed hypoxic ischemic encephalopathy and clarified the subdural hematomas in the posterior fossa causing mass effect and obstructive hydrocephalus. CONCLUSION: The aim of this report is to highlight the rarity and importance of mass-like subdural hematomas causing obstructive hydrocephalus, particularly in the setting of hypoxic ischemic encephalopathy and therapeutic whole-body cooling.