Bilateral Subdural Hematohygroma Associated With COVID-19 in Extremely Preterm Infant: A Case Study

Abstract

Introduction We present a rare case of a subdural hematohygroma following COVID-19 in an extremely preterm infant 3 months after birth. Case Presentation A preterm male infant delivered at 27 weeks of gestation via Caesarean section due to exacerbated maternal pulmonary hypertension, with a history of bronchopulmonary dysplasia, pulmonary hypertension, and prior CMV infection, was relatively stable in spite of the difficult circumstances. After developing COVID-19, the patient rapidly deteriorated, and neurosonography revealed a subdural hematohygroma as the cause. Although the hematohygroma regressed with bilateral subdurostomal reservoir implantation, the infant developed absorptive hydrocephalus. While initially controlled conservatively, a routine right cardiac catheterization procedure led to the development of a hydrocephalic-hypertensive crisis. The patient was stabilized but, despite ventriculoperitoneal shunting, ventriculomegaly did not resolve completely. Brain CT revealed widespread post-ischemic injury. Extensive damage resulted in various neurological deficits, necessitating intensive rehabilitation to support the child’s development. Discussion A subdural hematohygroma is a collection of cerebrospinal fluid and blood in subdural spaces that can occur as a consequence of acute trauma, surgical procedures or, more rarely, infection [1, 2, 3]. Although various neurological manifestations of COVID-19 have been documented, reports on subdural hygromas are scarce, and the full spectrum of possibilities for neurological involvement in COVID-19 remains unclear [4, 5]. Conclusions Although COVID-19 is not severe in most newborns, life-threatening conditions such as COVID-19-associated subdural hematohygroma can occur during the neonatal period. This case report aims to expand the knowledge of COVID-19 neurological manifestations in preterm infants.