Non-traumatic bilateral subdural hematoma in a 1-year-old child with optic glioma: a rare case report and literature review.

Introduction and importance: Subdural hematoma (SDH) is an uncommon but potentially life-threatening condition in pediatric patients, most frequently associated with trauma or coagulation disorders. Non-traumatic bilateral SDHs are particularly rare, especially in children undergoing treatment for central nervous system tumors. Early recognition is critical, as delayed diagnosis may result in significant morbidity and mortality. Case presentation: We report the case of a 1-year-3-month-old male with a known optic glioma receiving chemotherapy, who presented with progressive head circumference enlargement (from 56 cm to 59 cm), somnolence, reduced oral intake, and a sunset eye sign. There was no history of trauma or coagulopathy. Brain magnetic resonance imaging revealed large bilateral subacute SDHs with significant mass effect and midline shift. Urgent neurosurgical evacuation with subdural drain placement was performed, yielding over 400 cc of hematoma. The patient demonstrated marked postoperative improvement, with resumption of oral intake within 48 hours and favorable clinical and radiological recovery. Clinical discussion: While pediatric SDHs are typically trauma-related, this case illustrates a rare non-traumatic presentation in a child with an optic glioma undergoing chemotherapy. The underlying mechanism remains unclear, with possible contributions from tumor-related intracranial pressure changes or treatment-associated vascular fragility. This case highlights the importance of routine surveillance, including serial head circumference monitoring and timely neuroimaging, in pediatric oncology patients. Conclusion: Non-traumatic bilateral SDHs can occur in children with optic glioma and may present with subtle clinical signs. Early recognition and prompt neurosurgical intervention are essential to achieve favorable outcomes.