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Acute Posterior Fossa Epidural Hematoma in a Newborn Infant With Menkes Disease

Takeuchi, Satoru MD*; Horikawa, Masahiro MD; Wakamatsu, Hajime MD; Hashimoto, Jyunya MD; Nawashiro, Hiroshi MD*

doi: 10.1097/PEC.0000000000000078
Illustrative Cases

Abstract: Epidural hematoma (EDH) in newborn infants is rare compared with other types of intracranial hemorrhages. Furthermore, posterior fossa EDH is extremely rare. We present a case of posterior fossa EDH in an infant with Menkes disease with accessory bones in the occiput. A male infant with a condition diagnosed with Menkes disease by prenatal testing was born at 39 weeks via vacuum extraction. The patient presented with a mild tremor at 2 days after delivery. A brain computed tomography (CT) scan showed an acute EDH in the posterior fossa, extending into the occipitoparietal area. Three-dimensional CT and bone window CT scan revealed several accessory bones, diastasis of 1 accessory suture, a communicated fracture, and a linear fracture in the occipital bone. Furthermore, a bone fragment from a communicated fracture displaced toward the inside. The patient was treated conservatively for EDH because of his good general condition. The hematoma gradually resolved, and his tremor did not recur. We suggest the following mechanism of posterior fossa EDH development in our patient: (1) external force was applied to the occiput inside the birth canal during delivery, resulting in diastasis; (2) a communicated fracture occurred, and a bone fragment displaced toward the inside (linear fracture was caused indirectly by the force); (3) a transverse sinus was injured by the fragment; and (4) EDH developed in both the posterior fossa and supratentorial region. Copper deficiency can also cause fragility of connective tissues, vessels, and bones.

From the Departments of *Neurosurgery, †Radiology, and ‡Pediatrics, National Defense Medical College, Saitama, Japan.

Disclosure: The authors declare no conflict of interest.

Reprints: Satoru Takeuchi, MD, Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.