Management severe subdural
Hematoma in Neonate: intratecal infusion streptokinase for clot lysis.
Larionov S.N., Sorokovikov V., A.,
Novozilov V.A
Department Neurosurgery of Scientific Center of Reconstructive and
Restorative Surgery of Eastern-Siberian Scientific Center Siberian Branch of
Russian Academy of Medical Sciences, Bortzov Revolutsii 1, Irkutsk, Russia.
E-mail: snlar@mail.ru
Objective and Importance: The subdural
hematomas among full-term infants have the potential to cause death or lifelong
disability. A number of etiological factors have been proposed, including impairments
in coagulation, hypoxic-ischemic injury, venous sinus thrombosis, maternal
infection and birth-related trauma. We report a case management and outcomes
of newborn treated for subdural hematoma by drainage and subdural streptokinase
lavage.
Clinical presentation: A 1 month-old full-term baby presented with dyspnoea
and seizures. CT of the brain found an extensive panhemispheral subdural hematoma
on the left with thrombosis of the sigmoid and transverse sinuses.
Intervention: She underwent urgent surgery – external drainage and 25,000
units streptokinase infused at 0.5 ml/h for three days. For the following 72
hours, the drains conducted away a brown colliquation with fresh blood admixed
(about 160 ccm). The external drain was removed and subduro-subgaleal shunt
were placed. The neuroimaging (CT and MRI) revealed a residual fluid collection
in subdural space and recanalisation of the sigmoid and transverse sinuses.
Conclusion: Subdural infusion of streptokinase may have equal safety and efficacy
in lysing and following drainage subdural hematoma in newborn. Moreover, this
method is effective for treatment trombosis sigmoid and transverse sinuses
also.
