Traumatic Low Attenuation Subdural Fluid Collections in Children Younger Than 3 Years

Wells, Robert G.; Sty, John R.

doi:10.1001/archpedi.157.10.1005

Cited by 22 publications

(6 citation statements)

References 13 publications

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“…The appearances of a SDH in the acute setting can range from homogenous hyper-, hypo-or mixed density, in patterns which may be laminated, layered or sedimented. Low or mixed density subdural collections may develop within the first 24 hours after head injury (Wells et al 2002;Vinchon et al 2003Vinchon et al , 2004Wells and Sty 2003;Zouros et al 2004). The acute low density fluid in isolation or in association with acute SDH may be because actively bleeding unclotted blood (hypodense) is mixing with clotted hyperdense blood, or because there is Widened subdural spaces (particularly in the frontal region) and a small persistent high signal of a posterior fossa subdural are seen.…”

Section: Subdural Haemorrhage and Brain Injuriesmentioning

confidence: 99%

Non‐Sexual Abuse in Children

Minns¹,

Madea²,

Kernbach-Wighton³

2014

Handbook of Forensic Medicine

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Section: Subdural Haemorrhage and Brain Injuriesmentioning

confidence: 99%

Non‐Sexual Abuse in Children

Minns¹,

Madea²,

Kernbach-Wighton³

2014

Handbook of Forensic Medicine

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“…We recognize that it can be difficult to differentiate acute/chronic SDH from mixed-density acute SDH by SDH density alone on CT or MR images. 6,20,21,22 However, older injuries are indicated by other imaging findings such as SDH membranes and septations, global or focal old parenchymal brain injuries, skull fractures without soft-tissue swelling, and signs of chronic intracranial pressure. At the Seattle and Columbus sites, for ultimate determinations of SDH age, the radiologists' determinations were supplemented by additional radiological findings and clinical information such as head-size growth patterns, history of past neurological events, character of drained SDH fluid, and pathology.…”

Section: Study Limitationsmentioning

confidence: 99%

Initial clinical presentation of children with acute and chronic versus acute subdural hemorrhage resulting from abusive head trauma

Feldman¹,

Sugar²,

Browd

2015

PED

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OBJECT At presentation, children who have experienced abusive head trauma (AHT) often have subdural hemorrhage (SDH) that is acute, chronic, or both. Controversy exists whether the acute SDH associated with chronic SDH results from trauma or from spontaneous rebleeding. The authors compared the clinical presentations of children with AHT and acute SDH with those having acute and chronic SDH (acute/chronic SDH). METHODS The study was a multicenter retrospective review of children who had experienced AHT during 2004–2009. The authors compared the clinical and radiological characteristics of children with acute SDH to those of children with acute/chronic SDH. RESULTS The study included 383 children with AHT and either acute SDH (n = 291) or acute/chronic SDH (n = 92). The children with acute/chronic SDH were younger, had higher initial Glasgow Coma Scale scores, fewer deaths, fewer skull fractures, less parenchymal brain injury, and fewer acute noncranial fractures than did children with acute SDH. No between-group differences were found for the proportion with retinal hemorrhages, healing noncranial fractures, or acute abusive bruises. A similar proportion (approximately 80%) of children with acute/chronic SDH and with acute SDH had retinal hemorrhages or acute or healing extracranial injures. Of children with acute/chronic SDH, 20% were neurologically asymptomatic at presentation; almost half of these children were seen for macrocephaly, and for all of them, the acute SDH was completely within the area of the chronic SDH. CONCLUSIONS Overall, the presenting clinical and radiological characteristics of children with acute SDH and acute/chronic SDH caused by AHT did not differ, suggesting that repeated abuse, rather than spontaneous rebleeding, is the etiology of most acute SDH in children with chronic SDH. However, more severe neurological symptoms were more common among children with acute SDH. Children with acute/chronic SDH and asymptomatic macrocephaly have unique risks and distinct radiological and clinical characteristics.

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“…This is important in the context of head injury because if the arachnoid membrane is damaged at the time of head injury, CSF can leak into the subdural space and either collect there or dilute any acute subdural blood that is present. 11,12 These mixtures of acute blood and CSF are called acute traumatic effusions, and, when they occur, they appear as subdural collections that are darker than the underlying brain on CT, thus mimicking chronic (or subacute) subdural haematomas ( Figure 5). This is extremely important in the context of AHT, as it means that, in many of the cases where the initial radiology report is of acute and chronic or acute on chronic subdural bleeds, the subdural abnormalities are actually due to the presence of both discrete collections of acute subdural blood and acute traumatic effusions, i.e.…”

Section: Assessment Of the Age Of Subdural Bleedingmentioning

confidence: 99%

The importance of neuroimaging in abusive head trauma

Stoodley¹,

Williams²

2014

Imaging

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A shaking event is a common mechanism in abusive head trauma (AHT). • AHT is associated with greater morbidity and mortality than accidental (usually impact) head trauma. • AHT gives rise to different patterns of subdural haemorrhage (SDH) and parenchymal brain injury from impact head trauma. • Multifocal SDH is best regarded as a marker of a mechanism of injury but does not itself cause symptoms and signs. • Associated parenchymal brain injury leads to symptoms and signs and relates to outcome. • Published standards for the radiological investigation of AHT are available and should be followed.

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Traumatic Low Attenuation Subdural Fluid Collections in Children Younger Than 3 Years

Abstract: Low attenuation subdural fluid collections (distinct from clotted blood) in infants and young children with head injuries most often develop during the first week after the traumatic event.

Cited by 22 publications

References 13 publications

Non‐Sexual Abuse in Children

Non‐Sexual Abuse in Children

Initial clinical presentation of children with acute and chronic versus acute subdural hemorrhage resulting from abusive head trauma

The importance of neuroimaging in abusive head trauma

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