Bridging veins and autopsy findings in abusive head trauma

Rambaud, Caroline

doi:10.1007/s00247-015-3285-0

Cited by 44 publications

(17 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Caution is required to avoid injury to the bridging veins, which are severely stretched in such cases. The bridging veins play an important role in abusive head trauma, as they are susceptible to acceleration/deceleration, rotational, and shear forces and their subsequent rupture causes subdural hemorrhage [ 13 ]. Of note, bridging vein thrombosis has also been described as a sequel to head injury and was observed in the present case.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Lavage of Extensive Chronic Subdural Hematoma in an Infant After Abusive Head Trauma: Adaptation of a Technique From Ventricular Neuroendoscopy

Beez

Schmitz

Steiger

et al. 2018

Cureus

View full text Add to dashboard Cite

Subdural fluid collections are frequently encountered in young children after non-accidental injury. In a subset of patients, these collections progress in size and ultimately require permanent drainage, which is commonly achieved with subdural-peritoneal shunts. However, excessive protein and cellular contents in the fluid are potential risk factors for shunt failure. Here, we describe the adaptation of an endoscopic lavage technique established for ventricular endoscopy with the aim of improving fluid condition prior to shunting. We present a case of subdural fluid collections secondary to non-accidental injury, where permanent shunting was required but could not be performed due to excessive protein and cellular levels in the subdural fluid despite conventional burr hole drainage. A two-month-old male infant presented with a bulging and tense fontanel, a reduced level of consciousness, bradycardia, and significant macrocephaly. Computed tomography (CT) demonstrated massive bilateral, low attenuation subdural fluid collections, reaching a diameter of 4.5 cm. Emergency burr hole washout and insertion of subdural drains was performed. Despite prolonged drainage over 10 days, the protein level remained at 544 mg/dl and the mean erythrocyte count at 6,493/µl. Continuous drainage was required to avoid clinical deterioration due to raised intracranial pressure; however, the fluid condition was still considered incompatible with permanent subdural-peritoneal shunting. We, therefore, performed an endoscopic subdural lavage with a careful evacuation of residual blood deposits. No complications were encountered. Postoperatively, mean protein level was 292 mg/dl and mean erythrocyte count was 101/µl. Endoscopic lavage could be safely performed in a case of extensive subdural low attenuation fluid collections, where conventional burr hole drainage failed to improve protein and cellular contents as a prerequisite for successful permanent shunting. We conclude that adaptation of this technique can be helpful in selected cases as an alternative procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic Lavage of Extensive Chronic Subdural Hematoma in an Infant After Abusive Head Trauma: Adaptation of a Technique From Ventricular Neuroendoscopy

Beez

Schmitz

Steiger

et al. 2018

Cureus

View full text Add to dashboard Cite

show abstract

“…Bei den Brückenvenen handelt es sich um bis zu 50 überwiegend im Subarachnoidalraum verlaufende, im Durchmesser zwischen 0,05 und 3,07 mm große Venen, welche die Kortikalvenen der Oberflächen von Groß-und Kleinhirn mit den großen venösen Sinus verbinden und dabei den inneren Anteil der Dura mater penetrieren [11]. Gruppen von Brückenvenen können vor allem frontal, parietal, temporal und zerebellär gefunden werden [12,13]. Daneben kommen aber auch anatomische Abweichungen vor.…”

Section: Hintergrundunclassified

Brückenvenenverletzungen bei Schütteltrauma

et al. 2020

View full text Add to dashboard Cite

ZusammenfassungDas Schütteltrauma-Syndrom ist eine häufige Variante misshandlungsbedingter Kopfverletzungen bei Säuglingen und Kleinkindern und nach wie vor Gegenstand intensiver Forschungsbemühungen. Unter Verwendung verschiedener Bildgebungsmodalitäten wurden in den letzten Jahren mehrere Studien zur diagnostischen und forensischen Relevanz traumatisierter Brückenvenen durchgeführt. Im vorliegenden Beitrag werden der aktuelle Forschungsstand dargestellt und forensische Implikationen erörtert. Im Ergebnis der Metaanalyse der sieben gegenwärtig vorliegenden Untersuchungen ist festzustellen, dass Brückenvenenverletzungen bzw. Brückenvenenthrombosen häufig als rundlich und erweitert wirkende bzw. tubulär gestaltete Strukturen imponieren. Das „Tadpole“-Zeichen kann hierfür als ein wertvolles Hilfsmittel zu deren Identifizierung dienen. Insbesondere T2*/SWI-Sequenzen ermöglichen eine gute Detektierbarkeit dieser Läsionen und sollten bei Verdacht auf eine misshandlungsbedingte Kopfverletzung immer zusätzlich erstellt werden. Schlussfolgernd ist zu empfehlen, dass das Vorhandensein von radiologisch detektierbaren Brückenvenenverletzungen stets Anlass dazu geben sollte, auch nach weiteren Anzeichen einer Kindesmisshandlung zu suchen.

show abstract

“…Extra-axial blood clots with a tubular shape in the parasagittal regions are suggestive of an acute bridging vein thrombosis (Fig 8) (27). The lollipop sign and tadpole sign are terms coined to describe bridging veins that terminate abruptly with overlying focal hyperattenuation.…”

Section: Bridging Vein Thrombosismentioning

confidence: 99%

Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas

et al. 2019

View full text Add to dashboard Cite

Infants and children under 2 years of age are at greatest risk for devastating neurologic complications following nonaccidental trauma. While a subdural hematoma (SDH) is the most common finding and is often enough to raise suspicion for abuse, no single injury is pathognomonic for abusive head trauma (AHT). Rather, the combination of imaging and physical findings and the clinical presentation help confirm the diagnosis of AHT. Familiarity with the spectrum of findings and proper identification of the imaging abnormalities is important for the radiologist to facilitate treatment and removal of the patient from the abusive environment. Injury is usually a result of shaking, which includes hyperflexion, hyperextension, and rotational forces, and less commonly impact trauma or a combination of both. Key anatomic features unique to the infant's head, neck, and spine and associated biomechanical forces are responsible for entities such as hypoxic ischemic injury, bridging vein thrombosis, SDH, parenchymal lacerations, and spinal and retinal injuries. Although the association of subpial hemorrhage with AHT has not been investigated, it warrants attention in very young infants who endure accidental or inflicted trauma. A combination of CT of the head and MRI of the brain and cervical spine aids in the accurate diagnosis, appropriate management, and subsequent protection of these patients. ©

show abstract

Bridging veins and autopsy findings in abusive head trauma

Cited by 44 publications

References 16 publications

Endoscopic Lavage of Extensive Chronic Subdural Hematoma in an Infant After Abusive Head Trauma: Adaptation of a Technique From Ventricular Neuroendoscopy

Endoscopic Lavage of Extensive Chronic Subdural Hematoma in an Infant After Abusive Head Trauma: Adaptation of a Technique From Ventricular Neuroendoscopy

Brückenvenenverletzungen bei Schütteltrauma

Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas

Contact Info

Product

Resources

About