Superior cerebellar artery infarct in an infant caused by a large contralateral subdural hematoma
Presentation
Infant male accidentally dropped from 4 ft height. Initially alert, then lethargic. R pupil non reactive
Patient Data
Right large holohemispheric acute subdural hematoma, mixed density, with right to left midline shift. Smaller left vertex acute subdural hematoma.
Postoperative study demonstrating resolution of midline shift and residual right>left acute subdural hematoma. Subtle hypointensity of left superior cerebellum.
Four days post op there is restricted diffusion in the territory of the left superior cerebellar artery. Restricted diffusion is also seen in the anterior corpus callosum, in the right superior frontal lobe, and in the inferior frontal lobes bilaterally. T2 more clearly demonstrates the left cerebellar infarct in the territory of the superior cerebellar artery.
Case Discussion
This large right sided subdural hematoma was caused by a torn right vein of Trolard, discovered by the neurosurgeon during craniotomy. This is a rare of complication of a short (4 foot) accidental head injury. Herniation is a rare cause of infarction in the area of the superior cerebellar artery.
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