Chronic Subdural Hematoma in Infants

Sherwood, David

doi:10.1001/archpedi.1930.01930170065007

Cited by 39 publications

(16 citation statements)

References 13 publications

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“…Within the same decade, the standard management of chronic subdurals in adults evolved to single burr hole evacuation. Similar pathologic findings were recognized as occurring in infants [24,25], but the clinical presentation and disease progression were quite different. Pcet and Kahn [17] re viewed their experience with subdural hematomas in 9 infants and concluded that an aggressive surgical ap proach was justified despite the high mortality associated with this condition.…”

supporting

confidence: 59%

Pediatric Chronic Subdural Hematoma: A Retrospective Comparative Analysis

Parent¹

1992

Pediatr Neurosurg

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supporting

confidence: 59%

Pediatric Chronic Subdural Hematoma: A Retrospective Comparative Analysis

Parent¹

1992

Pediatr Neurosurg

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“…Small, acute SDHs can spontaneously rebleed over time or rebleed with minimal impact forces to the head and become chronic SDHs. [81][82][83][84][85][86][87] As they enlarge and become chronic SDHs, they can reach a critical size and then become clinically apparent with the classic signs of the triad. Whitby et al reported that a prospective head magnetic resonance imaging study within 48 hours of birth of 111 normal term babies showed that 9 (8.1%) had a SDH.…”

Section: Discussionmentioning

confidence: 99%

Overrepresentation of Males in Traumatic Brain Injury of Infancy and in Infants With Macrocephaly

Miller

2010

American Journal of Forensic Medicine &Amp; Pathology

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Shaken baby syndrome (SBS) has been thought to be caused by violent shaking of an infant and is characterized by the triad of findings: subdural hematoma (SDH), retinal hemorrhages, and neurologic abnormalities. The triad is not specific for SBS and can be seen in accidental trauma and in certain medical conditions. Recent observations, however, question whether SBS exists. Herein, we review the gender differences in 3 groups of infants with traumatic brain injury: (1) neonates with SDH from birth trauma, (2) infants with SDH from accidental trauma, and (3) infants with SDH from SBS. Gender differences are also presented in a fourth group of infants with macrocephaly related to increased extra-axial fluid spaces (IEAFS). Compared with the expected male frequency of 51.4% in newborns, there was a statistically significant overrepresentation of males in each of the 4 groups-65.3%, 62.2%, 62.6%, and 68.8%, respectively. We believe that the most likely explanation for these findings relates to the larger head size of the male compared with the female which has several relevant consequences. First, the larger head circumference of a male newborn compared with a female newborn may increase the likelihood that a male newborn will incur a small SDH from the minor trauma of the birthing process that can later rebleed and present with a symptomatic SDH that could be misdiagnosed as SBS and child abuse. Second, a short fall would have a greater likelihood of causing a SDH in a male infant than a female infant who could subsequently become symptomatic from hours to weeks later and could thus present as an unexplained SDH. Third, infants with macrocephaly related to IEAFS may be at increased risk for developing a SDH from the larger head size and greater tautness of the bridging vessels in the extra-axial fluid spaces. We believe that many infants who have been diagnosed with SBS have been given incorrect diagnoses of child abuse. Rather, their SDH may occur as a result of a small SDH from the birthing process that enlarges during early infancy, a short fall, or from macrocephaly with IEAFS.

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“…This author's personal experience concurs with the literature, that fatal or indeed even serious head injury in children under the age of 2 years from accidental trauma, other than that sustained in road traffic accidents or falls from major heights, is exceedingly rare. Two early reviews accepted that the subdural haematomas in the reported cohort were accidental in origin but both refer also to the coexistence of suspicious other injuries and the difficult and unsatisfactory social background in the ªunexplainedº though presumed accidental subdurals [34,35].…”

Section: Skull Fracturesmentioning

confidence: 99%