Table 1: Subdural hemorrhage grading
Subdural hemorrhages are associated with the age of the injury (Table
1). Both acute and subacute hemorrhages may occur from birth injury or abuse
in infants. Crescent-shaped lesions at the surface of the brain are often
associated with mass effect and cortical edema (Figure 2). Operative
intervention is indicated when neurologic decompensation occurs with both
subdural hemorrhage and parenchymal injury. Acute subdural hematomas
have a worse prognosis than epidural hematomas due to the underlying brain
damage. Patients with a midline shift greater than 5 mm should be promptly
taken to the operating room for neurosurgery evacuation.
Figure 2: Subdural hematoma: Note the concave or crescent-shaped appearance associated
with mass effect and loss of ventricles.
Subarachnoid hemorrhages are also common in children. Subarachnoid
bleeding in acutely traumatized children is common and rarely the result of
aneurysmal bleeding (Figure 3). If associated with minor trauma, surgical
intervention may not be warranted. However, hydrocephaly may occur in
subarachnoid hemorrhages requiring ventricular shunting to decrease the