Chronic Subdural Subtentorial Hematoma

Case I. Robert M. was 4 years old when first seen at the Children's Hospital of Michigan because of headache, drowsiness, vomiting, and unsteadiness on his feet of 6 weeks' duration. He had been delivered with forceps after a long difficult labor. He still carried prominent forceps markings behind each ear and a deep scar over the occiput. During the first few months of life he developed a marked prominence of the occipital portion of the skull. His head was always unusually large with frontal bossae. During the first 18 months he was difficult to feed, but apparently developed normally after this time until 6 weeks previous to my examination, when his vomiting began. I first saw the boy on May 28, 1931, when he was admitted to the Children's Hospital of Michigan. At that time he was lethargic and had a stiffness of the neck muscles. His discs were choked 4 to 5 diopters and he showed a fine lateral nystagmus. There-was ataxia in the finger-nose test on the right side, and atonia of both arms, especially the left. It was my impression that the child had a cerebellar tumor. X-rays of the skull showed no separation of the sutures, although the skull was larger than normal. Ventriculograms were made, which revealed a generalized and symmetrical enlargement of the ventricles. On June 17, 1931, through a Cushing crossbow incision, the suboccipital bone was rongeured away without difficulty. On opening the dura a thinwalled subdural cyst was found taking up the normal position of the right cerebellar lobe. When opened, the cyst contained three ounces of light yellow fluid. The cyst wall was smooth and had the appearance of the membrane usually found with the ordinary subdural hematoma. On teasing away this membrane, the normal right cerebellar cortex was uncovered deep in the cavity. The right lobe had a concave rather than a convex surface. The great space where the right lobe should have been was filled with saline and the flaps were closed in the usual manner.