The incidence, cause, and clinical outcome of subdural hemorrhage in children under 2 years of age were evaluated at the Department of Child Health, Bristol, Wales, UK. Of 33 cases identified, 28 were under 1 year of age. The incidence was 12.8/100,000 children/year (21/100,000 for infants under 1 year). Outcome was poor: 9 (27%) died and 15 (45%) had severe disability, including blindness in 9, seizures in 8, motor impairment in 7, and hydrocephalus in 5. Child abuse was subsequently suspected in 27 (82%), and previous physical abuse is a significant risk factor. In 14 a clear history of shaking was obtained. Only 22 had been adequately investigated. Mandatory evaluations suggested include social assessment, ophthalmologic exam, skeletal survey and bone scan, coagulation screen, and CT or MRI of head. [1]

COMMENT. Subdural hemorrhage in infants carries a poor prognosis, and child abuse is a major cause. Clinical presentation varies, with only general malaise in some and impaired consciousness in others. One in 5 is admitted to hospital on several occasions because of drowsiness and lethargy, before the diagnosis of subdural hemorrhage is suspected.