Cerebral Infarction Associated with Acute Subdural Hematoma in Infants: A Rare Entity from Northeastern India

Purpose: Cerebral infarction associated with acute subdural hematoma (CIASDH) is a rare and devastating entity. Methods: Infants diagnosed with CIASDH between July 2023 and June 2024 were included in this study. The modified pediatric Alberta Stroke Program Early Computed Tomography Score (pedASPECTS) and posterior circulation ASPECTS (pc-ASPECTS) were calculated for each infant. Outcomes were evaluated at 12 months using the modified Rankin scale (mRS) and the Developmental Assessment Scale for Indian Infants. Results: The 17 infants included in the study had a mean±standard deviation age of 3.29±2.23 months, presented with refractory status epilepticus, and exhibited moderate global developmental delay at 12 months. The etiologies of acute subdural hematoma (ASDH) were minor blunt trauma (30%), sepsis-associated coagulopathy (35%), and late-onset hemorrhagic disease of the newborn (HDN) (35%), the latter two being novel etiologies. Infants with HDN had significantly lower mean age and thicker hematomas. The extent of the category 6 infarcts (per the Childhood Arterial Ischemic Stroke [AIS] Standardized Classification and Diagnostic Evaluation criteria) did not differ significantly among the three groups and was not significantly correlated with ASDH severity. The mean pedASPECTS and pc-ASPECTS were 20.65±6.88 and 7.37±1.24, respectively, and these parameters displayed significant moderate correlations with the 12-month mRS. We noted novel radiological findings, including brainstem infarcts, CIASDH associated with falx interhemispheric ASDH, and luxury hyperperfusion. Conclusion: We describe novel etiologies and radiological findings in CIASDH and identify pedASPECTS and pc-ASPECTS scores as prognostic markers of outcome.