The emperor has no clothes

Rorke-Adams, Lucy B.; Christian, Cindy W.

doi:10.1007/s00247-009-1290-x

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Recently, some have suggested that hypoxia may cause subdural hemorrhage (7)(8)(9)(10)(11)14). This theory is not supported by the multitude of asphyxial deaths that are investigated each year (both radiographically and pathologically) that are found not to have subdural hemorrhage (13,(16)(17)(18)(19)(20)(21)(22)(23). Radiologic studies have not demonstrated an association between SDH and HIE (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Subdural Hemorrhage and Hypoxia in Children Less than Two Years Old

McCubbin

Thoma²,

Mena

et al. 2013

Academic Forensic Pathology

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The majority of subdural hemorrhages (SDH) are due to acceleration-deceleration forces associated with blunt head injury. So-called spontaneous subdural hemorrhages are described with coagulopathies, hemodialysis, hemophilia, and as extensions of hemorrhages due to other causes such as ruptured cerebral artery aneurysms. Recently, some have proposed that hypoxia causes subdural hemorrhage in infants and children. Materials and Methods: Of 1,190 deaths of children younger than two years of age, we analyzed 366 that were due to asphyxial mechanisms, respiratory disease, prematurity, seizures, and perinatal hypoxic-ischemic encephalopathy. All underwent autopsy and 97% included a consultant neuropathology examination. Results: Of the 366 decedents, hypoxic-ischemic encephalopathy (HIE) was diagnosed in 73 (20%) and evidence of subdural hemorrhage in 34 (9%). Of the 73 HIE deaths, 14 (19%) had SDH. Among these 14, 12 involved prematurity and/or perinatal HIE. Among the 20 fatalities with SDHs but without HIE, all were premature infants and/or had a SDH that pathologically pre-dated the putative hypoxic-ischemic event. Of the 34 SDHs, 24 were organized neomembranes and ten were organizing hemorrhages. Discussion: SDHs that are not caused by acceleration-deceleration forces are routinely recognized in infants and children. Usually, they are clinically silent and may be associated with prematurity and perinatal birth events. At autopsy, subdural neomembranes frequently are incidental findings in infants and children who die from a variety of causes. This study does not support the theory that hypoxic-ischemic injury in infants and children causes subdural hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Subdural Hemorrhage and Hypoxia in Children Less than Two Years Old

McCubbin

Thoma²,

Mena

et al. 2013

Academic Forensic Pathology

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“…They presented concepts that are new to many of our readers, and one of the ways that medicine advances is when our longheld beliefs are challenged. We have published in this issue a number of letters [2][3][4] that we have received in response to their paper and the accompanying editorial [5]. In the July issue we published correspondence from Drs.…”

mentioning

confidence: 99%

Response to Galaznik, Cohen & Scheimberg, and Rorke-Adams & Christian

Chapman

Slovis

2009

Pediatr Radiol

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“…Rorke-Adams and Christian [1] should refer to a king whose greatest fault is hubris, and who, at the end of the tale, thinks to himself "but I must bear up to the end" as he tries to walk away with false dignity [2]. In the fable, the emperor tenaciously refuses to acknowledge the evidence of his own lack of clothing, since it is in conflict with what he wishes to believe.…”

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confidence: 99%

“…To be equally blunt in our reply, it is inappropriate to regard infantile SDH solely as the "consequence of inflicted or accidental trauma" [1]. To view all infants who present with SDH as victims of trauma is to use too narrow a lens; such a limited frame of reference invites cognitive errors [3].…”

mentioning

confidence: 99%