Introduction: Cerebral infarction following acute subdural hematoma (CIASDH) is described as occurrence of hypodensity lesions on computed tomography (CT) following acute subdural hematoma in infants and young children due to accidental /non accidental injury. Predictors of CIASHDH reported are seizure, consciousness disturbance at admission, absence of skull fracture, hematoma thickness of 5mm and midline shift of 3mm on CT. We present two rare cases of CIASDH in children.

Case Description: Both our patients presented with altered mental state and seizures with a history of significant head trauma. Initial CT scan Brain showed ASDH with significant midline shift (3mm and 5mm in respective cases) with subsequent CT scan Brain (done in view of worsening neurological function) revealed acute infarction in ipsilateral fronto-parieto-occipital areas with no increase in size of hematoma. However CT Angiography and Venography of Brain and Neck was normal. MRI Brain-DWI (Diffusion weighted imaging) showed restriction (low ADC value) in above-mentioned areas with MR Angiography being normal. Four predictors (seizure, midline shift of 3mm, consciousness disturbance, absence of skull fracture) were positive in our cases.

Conclusion: Predictors for CIASDH may be crucial to identify this devastating phenomenon at an early stage to enable the physicians for appropriate medical/surgical intervention that could be life saving.