Examining perinatal subdural haematoma as an aetiology of extra‐axial hygroma and chronic subdural haematoma

Abstract

Aim Benign external hydrocephalus (BEH), hygroma and chronic subdural haematoma are extra‐axial fluid collections in infants. MRI studies have shown that almost half of all new‐borns have perinatal subdural blood, generally referred to as subdural haematoma (SDH) or perinatal SDH. Epidemiologically there are striking similarities between chronic SDH and BEH in infants. Methods Discussion of pathophysiological mechanisms for BEH and chronic SDH, based on existing literature. Results Perinatal SDH is common, and we hypothesise that this condition in some infants develop into extra‐axial fluid collections, known as hygroma, BEH or chronic subdural haematoma. The mechanism seems to be an intradural bleeding that creates an obstructive layer preventing normal CSF absorption. The site where the bleeding originates from and those areas enveloped in blood from the primary damaged area are prone to later rebleeds, seen as ‘acute on chronic’ haematomas. With steady production of CSF and the blockage, increased intracranial pressure drives the accelerated skull growth seen in many of these children. Conclusion Perinatal SDH hampers CSF absorption, possibly leading to BEH and chronic SDH, with a high risk of false accusations of abuse. Close monitoring of head circumference could prove vital in detecting children with this condition.

Do Child Abuse Pediatricians Search for a “Pediatric Vulcan Planet”? Comparison of Controversies about the Vulcan-Must-Exist-Theory and the Infant-Must-Have-Been-Shaken-Theory

“…In other words, the ad hoc closure clause, that all relevant medical conditions have been excluded, is certainly false. This is supported by the non-shaken baby theory by Geddes et al and benign external hydrocephalus (Geddes, Vowles, Hackshaw, Nickols, Scott, & Whitwell, 2001;Geddes, Tasker, Adams, & Whitwell, 2004;Zahl, Wester, & Gabaeff, 2020).…”

“…Finally, claims that a caregiver is lying if he/she cannot explain why the infant has developed the triad signs and symptoms may seem reasonable-but only if the OUAHT theory with all its ad hoc hypotheses and clauses are presupposed to be true, or at least truth-like. They are, however, contradicted by biomechanical studies, as well as by several non-shaken baby theories, which indicate that the triad might develop spontaneously, or represents the sequelae of a delivery-associated SDH (Zahl, Wester, & Gabaeff, 2020). In other words, in triad cases without signs of external trauma, no obvious events have necessarily occurred prior to the infant´s collapse.…”

“…It was suggested that the SDH was the result of leakage from small veins and capillaries, not rupture of bridging veins Geddes, Tasker, Adams, & Whitwell, 2004). Neuroimaging studies supported the hypoxia theory and other research groups have subsequently published studies which support the hypoxia theory (Acres & Morris, 2014;Kemp, Stoodley, Cobley, Coles, & Kemp, 2003;Oehmichen, Schleiss, Pedal, Saternus, Gerling, & Meissner, 2008;Cohen, 2009;Cohen, Sprigg, & Whitby, 2010 Squier, & Eastman, 2009;Zahl, Wester, & Gabaeff, 2020).…”

“…There are, however, signs that non-shaken baby theories byGeddes et al and by others might introduce a range of fruitful research areas(Acres & Morris, 2014; Lynøe, Juth, & Eriksson, 2019; Mack, Squier, & Eastman, 2009;Zahl, Wester, & Gabaeff, 2020). We suggest that the non-shaken baby theories could have a similar effect on the OUAHT theory and the derived the infant-must-have-been-shaken-theory as did Einstein's general relativity theory combined with Eddington's and Dyson's observational support upon the OUNG theory and the derived Vulcan-must-exist-theory.2.3 The Reception of the Theories by Einstein and Geddes et alThere were discrepancies in how the two theories and the supporting observations were received.…”

Thrombosis is not a marker of bridging vein rupture in infants with alleged abusive head trauma

“…Disagreement still exists as to whether BEH is a risk factor or not. 76,77 A recent review investigated the similarities between SDH and BEH, and presented a unifying theory of pathophysiology behind these subdural collections 78 Few neuroimaging studies have reported findings of ruptured bridging veins, except the ones reviewed above. Findings such as the tadpole or lollipop signs lack pathologic verification of bridging vein injuries.…”