Enlarged cerebrospinal fluid spaces in infants with subdural hematomas.

Kapila, Ashwani; Trice, J.A.; Spies, William G.; Siegel, Barry A.; Gado, M

doi:10.1148/radiology.142.3.6977789

Cited by 41 publications

(30 citation statements)

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“…Benign external hydrocephalus has, however, been associated with subdural hematoma (SDH) [11, 12]. The incidence of SDH in children with BEH is suspected to be much higher than that seen in the general population, as in one group of children with BEH where the incidence of SDH was 3/20 [1, 13].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of SDH in children with BEH is suspected to be much higher than that seen in the general population, as in one group of children with BEH where the incidence of SDH was 3/20 [1, 13]. Thus, children with BEH seem to be predisposed to developing acute SDH either spontaneously or following minor head trauma [1, 10, 11, 13]. The etiology of SDH in the setting of BEH is also poorly understood but presumably derives from anatomical and geometric stresses on blood vessels in the enlarged SAS/subdural space [12, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

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A Theoretical Model of Benign External Hydrocephalus That Predicts a Predisposition towards Extra-Axial Hemorrhage after Minor Head Trauma

Papasian

Frim²

2000

Pediatr Neurosurg

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Introduction: There is controversy over whether there exists a predisposition towards bleeding into the subdural space in infants with benign external hydrocephalus (BEH) or other enlargement of the extra-axial space (e.g. subdural hygroma). The presumed etiology implicates shear forces in over-stretching the extra-axial blood vessels. We have created a model of the intracranial space that approximates certain aspects of BEH. Using this model, we predict situations where children with BEH will bleed into the extra-axial space when normal infants will not. Methods: The cranial model consists of two spheres representing the brain and the skull. The distance between them represents the width of the extra-axial space. The spheres are concentric (with interspheric distance equal to N) in the normal condition and nonconcentric in BEH. In BEH, the distance between the two spheres varies from N to Q (0 < N ≤ Q) over a 906 M ≤ Q, with the translation orthogonal to the vector of N and parallel to that of M or vice versa), then the final length V_f of a vein V is V_f = (N² + M)^1/2, and the stretch ratio V_f/V_i is: V_f/V_i = (N² + M²)^1/2/N·S_i, with S_i the slack factor, where i represents either n for normal or b for BEH and M = N in the normal condition. Results: Given an equivalent capacity of veins to resist stretch injury (based on the proportion of change in length), for brain translations after a low-impact head injury, stretch ratios for BEH veins range from 1.677 to 3.436, whereas in the normal condition they range from 1.061 to 1.179. Therefore, for an increase in subarachnoid space from 3 (normal) to 6 mm (BEH), brain translocation in BEH will stretch veins beyond an average breaking point when the translation for the normal condition will not. Conclusions: Mathematical modeling of the cranial vault produces a relationship between venous stretch and the width of the extra-axial space. These equations predict an increased frequency of venous stretch injury in the situation of widened extra-axial space. Such venous injury is consistent with forces generated by minor trauma. This relationship, as predicted by our model, could underlie a predisposition towards extra-axial bleeding after minor head trauma in infants with BEH.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Theoretical Model of Benign External Hydrocephalus That Predicts a Predisposition towards Extra-Axial Hemorrhage after Minor Head Trauma

Papasian

Frim²

2000

Pediatr Neurosurg

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“…6 Some investigators have suggested that children with macrocrania and enlargement of the SS may be at increased risk for subdural hemorrhage (SDH) after minimal or no trauma. [7][8][9][10][11][12][13][14][15] A clinical dilemma often arises when subdural collections (SDC) are identified in children with enlarged SS because the identification of SDC in an infant without an appropriate traumatic history raises the concern for abusive head trauma (AHT). 3,12,16,17 The literature connecting enlarged SS and risk of SDC is based predominately on case reports or small case series.…”

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confidence: 99%

Prevalence of Subdural Collections in Children with Macrocrania

Greiner

Richards

Caré

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The relationship between enlarged subarachnoid spaces and subdural collections is poorly understood and creates challenges for clinicians investigating the etiology of subdural collections. The purpose of this study was to determine the prevalence of subdural collections on cross sectional imaging in children with macrocephaly correlating with subarachnoid space enlargement.

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“…Approximately 30 years earlier, it was hypothesized that concurrent traumatic subarachnoid hemorrhages, that are frequently found together with SDHy, may secondarily predispose to defective CSF resorption leading to enlargement of subdural CSF collections as well. 43,68,69 In the end, SDHys represent a subsequent result of ence of SDHy may be medicolegally interpreted as later consequence of AHT that occurred some days or a few weeks before.…”

Section: Concept 1: Delayed Formation Of Subdural Hygromasmentioning

confidence: 99%

Subdural Hygromas in Abusive Head Trauma: Pathogenesis, Diagnosis, and Forensic Implications

Wittschieber¹,

Karger²,

Niederstadt

et al. 2014

AJNR Am J Neuroradiol

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SUMMARY:Are subdural hygromas the result of abusive head trauma? CT and MR imaging represent important tools for the diagnosis of abusive head trauma in living infants. In addition, in-depth understanding of the pathogenesis of subdural hygromas is increasingly required by neuroradiologists, pediatricians, and forensic physicians. Therefore, the current knowledge on subdural hygromas is summarized and forensic conclusions are drawn. The most important diagnostic pitfalls, benign enlargement of the subarachnoid space, and chronic subdural hematoma, are discussed in detail. Illustrative cases from forensic practice are presented. Literature analysis indicates that subdural hygromas can occur immediately or be delayed. If other infrequent reasons can be excluded, the presence of subdural hygromas strongly suggests a posttraumatic state and should prompt the physician to search for other signs of abuse. To differentiate subdural hygromas from other pathologies, additional MR imaging of the infant's head is indispensable after initial CT scan. ABBREVIATIONS:AHT ϭ abusive head trauma; BESS ϭ benign enlargement of subarachnoid space; BV ϭ bridging vein; cSDH ϭ chronic subdural hematoma;

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Enlarged cerebrospinal fluid spaces in infants with subdural hematomas.

Cited by 41 publications

References 0 publications

A Theoretical Model of Benign External Hydrocephalus That Predicts a Predisposition towards Extra-Axial Hemorrhage after Minor Head Trauma

A Theoretical Model of Benign External Hydrocephalus That Predicts a Predisposition towards Extra-Axial Hemorrhage after Minor Head Trauma

Prevalence of Subdural Collections in Children with Macrocrania

Subdural Hygromas in Abusive Head Trauma: Pathogenesis, Diagnosis, and Forensic Implications

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