Atlas of Neonatal Pathology: Cranial trauma

+ Introduction

+ Support

+ Neonatal pathology

Cranial trauma

Clinical signs

Caput succedaneum
- hemorrhagic oedema involving the skin and subcutaneous tissues over the presenting part
- has no clinical significance
- with vaccum extraction a more circumscribed oedema with significant bleeding and damage to the skin may occur
Cephalhematoma
- bleeding betwwen the periosteum and the bone, limited by bounderies of the individual bone
- parietal bones usually involved
- in up to 25% of cephalhematomas there is an underlying skull fracture
- the extent of hemorrhage is rarely significant
- commonly seen in uncomplicated vertex delivery
Subdural hemorrhage and tears of the dural folds
- commonly found together because both result from the same type of injury — excessive frontooccipital compression or oblique distortion of head
- tears of the dural folds in tentorium at the junction with falx or in the falx itself
- hemorrhage results form rupture of the bridging veins or rarely from extension of the dural tears into the sinuses
- relatively small hematomas in the posterior fossa can cause brain stem compression and death.
- on the other hand small hematomas over the hemispheres are usually asymptomatic, but major can present with obvious signs of acute blood loss or anemia
Skull fractures
- linear fractures of the parietal bones
- depressed fractures of the parietal bones
- multiradiate fractures of skull bones (usually parietal bones bilaterally) — associated with significant intracranial hemorrahage
Occipital osteodiastasis
- separation of the squamous and lateral parts of the occipital bone (these parts do not fuse until the second year of life)
- lower edge of the squamous occipital bone is displaced and rotated inward thus narrowing the foramen magnum
- in fatal cases the displacement causes compression of the posterior fossa without massive hemorrhage, or the dura and sinuses are torn resulting in gross subdural hemorrhage in the posterior fossa
- laceration of the cerebellum with cereberall emboli within pulmonary and other vessels have been reported
Spinal cord injury
- excessive longitudinal stretching of the neck in breech delivery or excessive rotation in verex delivery (minority of cases)
- grossly laceration or even total transection of the cervical cord is observed
- the fetus is stillborn or dies in the early neonatal period with respiratory failure
- serious spinal cord injuries occur etramely rare nowadays with increasing use of cesarean section in breech presentations