Anatomic Details of Intradural Channels in the Parasagittal Dura: A Possible Pathway for Flow of Cerebrospinal Fluid

Fox, Richard; Walji, Anil H.; Mielke, Bruce; Petruk, Kenneth C.; Aronyk, Keith

doi:10.1097/00006123-199607000-00017

Cited by 93 publications

(53 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Homogeneously hyperdense SDH was present in fewer than one-third of our cases; mixed-density SDH, containing both hyperdense and hypodense components, was present in over half of the infants in the present study, in onethird of children in our prior study, 9 and in 91% of infants with AHT in a third study by Vinchon et al 31 Mixeddensity SDH in AHT has been interpreted as prima facie evidence of serial injuries, 6,25 but this concept has recently been challenged. 9,11,32,33,39 One child in our previous study developed a hypodense subdural collection de novo on a second CT scan performed 19 hours after an initial scan showed no SDH in that region. 9 In another study of 18 infant victims of motor vehicle crashes with SDH, 3 infants had mixed-density SDH on the initial CT scan.…”

Section: Serial Changes On Ctmentioning

confidence: 85%

“…31 Several authors have hypothesized that mixed-density SDH may reflect an admixture of fresh clotted blood, unclotted blood or serum, and/or CSF from the subarachnoid space that has migrated into the subdural space through a tear in the arachnoid membrane. 9,11,33,39 A communication between the subarachnoid and subdural spaces in infants with SDH was confirmed in one study by injecting a radioisotope into the CSF via lumbar puncture at the time of subdural drain placement and identifying the radioisotope within the subdural fluid within 3-24 hours. 39 It is apparent that although mixed-density SDHs are more common after AHT, and some of these likely represent acute and prior injuries, the fact that they are also present early after presumably single accidental injuries makes their interpretation more difficult.…”

Section: Serial Changes On Ctmentioning

confidence: 94%

See 1 more Smart Citation

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Bradford¹,

Choudhary²,

Dias

2013

PED

View full text Add to dashboard Cite

Object The appearance and evolution of neuroimaging abnormalities following abusive head trauma (AHT) is important for establishing the time frame over which these injuries might have occurred. From a legal perspective this frames the timing of the abuse and therefore identifies and excludes potential perpetrators. A previous pilot study involving 33 infants with AHT helped to refine the timing of these injuries but was limited by its small sample size. In the present study, the authors analyzed a larger group of 210 cases involving infants with AHT to chronicle the first appearance and evolution of radiological (CT, MRI) abnormalities. Methods All children younger than 24 months admitted to the Penn State Hershey Medical Center with AHT over a 10-year period were identified from a medical record review; the time of injury was determined through an evaluation of the clinical records. All imaging studies were analyzed, and the appearance and evolution of abnormalities were chronicled on serial neuroimaging studies obtained in the days and weeks after injury. Results One hundred five infants with specific injury dates and available imaging studies were identified; a subset of 43 children additionally had documented times of injury. In infants with homogeneously hyperdense subdural hematomas (SDHs) on initial CT scans, the first hypodense component appeared within the SDH between 0.3 and 16 days after injury, and the last hyperdense subdural component disappeared between 2 and 40 days after injury. In infants with mixed-density SDHs on initial scans, the last hyperdense component disappeared between 1 and 181 days. Parenchymal hypodensities appeared on CT scans performed as early as 1.2 hours, and all were visible within 27 hours after the injury. Rebleeding into SDHs was documented in 17 cases (16%) and was always asymptomatic. Magnetic resonance imaging of the brain was performed in 49 infants. Among those with SDH, 5 patterns were observed. Patterns I and II reflected homogeneous SDH; Pattern I (T1 hyperintensity and T2/FLAIR hypointensity, “early subacute”) more commonly appeared on scans performed earlier after injury compared with Pattern II (T1 hyperintensity and T2/FLAIR hyperintensity, “late subacute”), although there was considerable overlap. Patterns III and IV reflected heterogeneous SDH; Pattern III contained relatively equal mixtures having different intensities, whereas Pattern IV had fluid that was predominantly T1 hypointense and T2/FLAIR hyperintense. Again, Pattern III more commonly appeared on scans performed earlier after injury compared with Pattern IV, although there was significant overlap. Conclusions These data extend the preliminary data reported by Dias and colleagues and provide a framework upon which injuries in AHT can be timed as well as the limitations on such timing estimates.

show abstract

Section: Serial Changes On Ctmentioning

confidence: 85%

Section: Serial Changes On Ctmentioning

confidence: 94%

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Bradford¹,

Choudhary²,

Dias

2013

PED

View full text Add to dashboard Cite

show abstract

“…All had characteristic pattern of biochemical abnormality including low plasma urate and high urinary sulphite, xanthines/ sulphocysteine. Burst suppression was seen in the neonatal period in all those who had EEG during this time (3).…”

mentioning

confidence: 72%

“…Recent resin injection studies have demonstrated a network of channels draining into the venous sinuses in close proximity to arachnoid granulations which are generally assumed to resorb CSF 2,3 . CSF resorption routes are poorly understood and a route via the dura has been suggested 4 .…”

Section: Referencesmentioning

confidence: 99%

See 1 more Smart Citation

Poster Presentations

2009

Develop Med Child Neuro

View full text Add to dashboard Cite

Background: Children with epilepsy and their parents are faced with a multitude of medical, developmental, social and emotional issues. These can place additional demands on the rearing of children, requiring comprehensive, continuing health care. Numerous research studies have identified parents' requirements for information and support essential in caring for a child with a chronic illness. Only a select number of studies have examined parents' requirements for information and support following their child's diagnosis of epilepsy. Objective: To explore the experiences of mothers of a child with epilepsy with specific emphasis on their informational and support needs. Methodology: A phenomenological hermeneutic methodological design provided an invaluable opportunity to gain an understanding and appreciation of the lived experiences and perceptions of mothers' needs for information and support following their child's diagnosis of epilepsy. Purposive sampling was utilised in this research study to selects participants because of their knowledge of the phenomenon to ensure credible and knowledgeable participants in the research study. Analysis: Colaizzi's (1978) six procedural steps were utilised in this research study to understand the phenomenon under investigation and facilitated participants with the opportunity to validate the credibility of the findings. Findings: The findings in this study revealed that mothers have a real need for information and support to enable them to care for their child with epilepsy. Their information and support needs are currently not being met by healthcare providers. Conclusion: There is a gap in provision of information and support needs specific to children with epilepsy and their parents. It is imperative that the specific needs of the child with epilepsy and their family are identified and met to ensure this ideal is espoused. To audit the management of children entered into the Leeds Regional Paediatric Epilepsy Surgery Programme since 2002 including outcomes of relevant surgical procedures. Method: Fifty-one children were entered into the programme during [2002][2003][2004][2005][2006][2007][2008]. Retrospective case note review was conducted and data collected included clinical and surgical evaluation and details of investigations such as MRI, Video Telemetry (VT) and Wada. Outcome was measured within the first month post-operatively and thereafter using ENGEL's classification 1 . A new database was created as part of this audit. Results: Twenty-two male and twenty-nine female children were identified. Twenty-four underwent surgery, with four requiring further surgical intervention. 36% of procedures were lesionectomies; 32% temporal lobectomies; 18% hemispherectomies and 10% resulted in the insertion of a vagal nerve stimulator. 20% were withdrawn from the programme because of improved seizure control. Average waiting time was 8.3 months for VT and 5.6 months for neuropsychological assessment including suitability for DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY POSTER P...

show abstract

Retino‐Dural Hemorrhage of Infancy

Squier

2013

Wiley Encyclopedia of Forensic Science

View full text Add to dashboard Cite

The term shaken baby syndrome (SBS), defined by the triad of retinal hemorrhage (RH), encephalopathy, and subdural hemorrhage (SDH), despite being widely accepted for 40 years, can no longer be regarded as a valid diagnosis. Multiple lines of evidence, from biomechanics to advances in understanding the anatomy and pathophysiology of the developing infant brain and its coverings, have undermined the diagnosis, and the nomenclature has been revised to reflect this. It is important to shift the focus to the objective pathological findings in babies with these closely interrelated phenomena rather than speculating on mechanisms; the term retino‐dural haemorrhage of infancy more accurately characterizes this syndrome. RHs have many causes and are more common after natural disease and accidents than after inflicted injury. Encephalopathy results from hypoxic‐ischemic injury rather than from traumatic axonal injury. Trauma is a cause of infant SDH, but there are many natural causes; almost half of normal newborns have SDH identified on brain scan. Infant SDH is usually a thin bilateral film, its source traditionally ascribed to torn bridging veins, but this remains unproved and is rarely documented. The dura is an alternative source; the infant dura is richly vascularized and innervated and bleeding into it is common. SDH evolves into a reactive membrane containing thin‐walled capillaries. Recurrent bleeding into these membranes is seen on microscopy. In some cases, SDH evolves into a chronic fluid collection; the causes for this are unknown. Biomechanical studies have shown that the forces generated by shaking are far less than those resulting from impact, but it remains correct to advise parents that babies should never be shaken. This article examines the pathology of each of these signs and their pathophysiology. The importance of considering the birth, early clinical history, and predisposing vulnerabilities when examining a case of suspected abuse is emphasized.

show abstract

Anatomic Details of Intradural Channels in the Parasagittal Dura: A Possible Pathway for Flow of Cerebrospinal Fluid

Abstract: These channels may represent a pathway for the flow of cerebrospinal fluid from AG to the SSS.

Cited by 93 publications

References 19 publications

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Poster Presentations

Retino‐Dural Hemorrhage of Infancy

Contact Info

Product

Resources

About