Tentorial laceration may produce a tear in the vein of Galen, straight sinus, or transverse sinus. Occipital osteodiastasis consists of a separation between the squama occipitalis and the lateral portion of the occipital bone. Occipital osteodiastasis may result in rupture of the occipital sinus. Infratentorial subdural hematoma may present clinically 2 to 4 days after birth in a previously normal neonate. Signs of brainstem dysfunction, increased intracranial pressure, and nuchal rigidity may be present. The most frequent signs of brainstem dysfunction are skew deviation unchanged by caloric testing, asymmetric pupils, and bradycardia.
ERRORS OF METABOLISM
inborn error of metabolism should be suspected in every comatose neonate.
The level of suspicion should be raised if the neonate has: (1) a peculiar
odor; (2) a combination of truncal hypotonia and limb hypertonia; (3)
brainstem dysfunction; (4) signs of increased intracranial pressure; (5)
stimulus-sensitive myoclonus; (6) abnormal respirations in the absence
of cardiac or respiratory disease; or (7) a family history of unexplained
death, metabolic disease, or parental consanguinity. A symptom-free interval
lasting for a few days after birth may occur with some inborn errors of