Acute Ventriculomegaly and Gaze Deviation after Evacuation of Subdural Hematoma: Report of an Unusual Case

Subdural hematomas (SDHs) in infants present diagnostic challenges due to their diverse aetiologies ranging from non-accidental injury to metabolic or coagulopathic disorders. Clinical presentation includes vomiting, irritability and bulging fontanelles. There are a multiple surgical and non-surgical options available for management aim at relieving mass effect. We report the unusual development of acute ventriculomegaly and downward gaze palsy in a clinically well 9-week-old boy following evacuation of bilateral subacute subdural hematomas. Neuroimaging revealed ventricular enlargement without other overt clinical features of hydrocephalus, and symptoms resolved without CSF diversion. We hypothesize that the ventriculomegaly and downward gaze deviation was caused by altered CSF pressure gradient due to communication between the subarachnoid, subdural, and subgaleal spaces.