Severe subdural hemorrhage due to minimal prenatal trauma

Piastra, Marco; Pietrini, Domenico; Massimi, Luca; Caldarelli, Massimo; Luca, Danièle De; Lungo, Laura Minguell Del; Carolis, Maria Pia De; Rocco, Concezio Di; Conti, Giorgio; Zecca, Enrico

doi:10.3171/2009.7.peds08223

Cited by 14 publications

(5 citation statements)

References 18 publications

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“…A total of 14 studies were included in the final analysis. 3,4,[7][8][9][10]13,[15][16][17]21,22,24,26 Of note, 2 studies described the same case and were combined for the purposes of this study. 17,21 The search flow diagram is shown in Fig.…”

Section: Results Study Selectionmentioning

confidence: 99%

Blunt prenatal trauma resulting in fetal epidural or subdural hematoma: case report and systematic review of the literature

Joseph

Smith

Garton

2017

PED

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Blunt prenatal trauma is known to have consequences to the developing brain, and can result in subdural hematoma (SDH) or epidural hematoma (EDH). The authors present a case of blunt prenatal trauma resulting in a fetal SDH, intraparenchymal hematoma, and intraventricular hemorrhage, and perform a systematic review of the literature. This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant studies (up to April 2016) that reported on cases of fetal SDH or EDH after blunt prenatal trauma were identified from the PubMed database. The primary outcome was fetal mortality, and the secondary outcome was neurological outcome. Fourteen studies were included in the analysis, comprising a total of 14 patients including the present case. The average gestational age at discovery of hemorrhage was 30.1 weeks. Nine mothers were in a motor vehicle collision and 3 were assaulted; the mechanism of injury for 2 mothers was not defined. Twelve patients had SDH, 1 had EDH, and 1 had conflicting reports. Three patients had intrauterine fetal demise, and 3 died in the neonatal period after birth. Three patients had persistent neurological deficit, and 5 were neurologically intact. Fetal SDH or EDH after blunt trauma to the mother trauma is rare and is associated with mortality. However, a significant number of patients can have good neurological outcomes.

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Section: Results Study Selectionmentioning

confidence: 99%

Blunt prenatal trauma resulting in fetal epidural or subdural hematoma: case report and systematic review of the literature

Joseph

Smith

Garton

2017

PED

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“…In utero skull fractures, intracranial bleeding, and severe brain injuries are uncommon but well documented, particularly in the setting of motor vehicle accidents (6)(7)(8)(9)(10)(11). Although the likelihood of fetal injury or death is greatest when maternal injury is severe, devastating injuries and poor outcomes have been reported when the mother showed minimal evidence of trauma (12).…”

Section: Discussionmentioning

confidence: 99%

Are Peripapillary Intrascleral Hemorrhages Pathognomonic for Abusive Head Trauma?*

Schoppe

Lantz

2012

Journal of Forensic Sciences

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The American Academy of Pediatrics' Committee on Child Abuse and Neglect, Section on Ophthalmology, acknowledges that searching for retinal hemorrhages (RHs) in infants only in cases of suspected of abuse creates selection bias. However, they also recommend that postmortem eye removal might not be indicated "in children who have clearly died from witnessed severe accidental head trauma or otherwise readily diagnosed systemic medical conditions." Although infrequently described in the child abuse literature, peripapillary intrascleral hemorrhages (bleeding in the sclera at the optic nerve insertion)--putatively from severe repetitive acceleration/deceleration forces with or without blunt head trauma--have been considered essentially pathognomonic for abusive head trauma (shaken baby syndrome). We present two neonates who sustained accidental, severe in utero head injuries and had associated extensive RHs and optic nerve sheath hemorrhages with peripapillary intrascleral hemorrhages detected at autopsy. Neither neonate had a documented clinical fundal examination in the intensive care unit.

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“…These diagnoses have followed work-ups, prompted by alarming prenatal ultrasound abnormalities, fetal symptoms, known trauma or immediate post-partum clinical findings. [3][4][5] However, clinically silent cases of intracranial extra-axial pathology arising in utero would likely go unnoticed until emerging symptoms after birth raised concerns.…”

Section: Discussionmentioning

confidence: 99%

A case for an in utero etiology of chronic SDH/effusions of infancy

Galaznik

2011

J Perinatol

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The authors report a case of chronic subdural hematoma/effusions (CSDHs) first suspected at 3 months of age after presenting with a seizure, and initially diagnosed as postnatal trauma. However, a close re-examination of fortuitously available serial prenatal ultrasounds clearly establishes the presence of an abnormal, expansive intracranial process already in place by 20-weeks gestation. With no identified prenatal, perinatal, or postnatal trauma, and no identified culpable medical condition as a potential etiology, this case raises the possibility that some, perhaps many or even most CSDHs of infancy can have a congenital etiology.

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Severe subdural hemorrhage due to minimal prenatal trauma

Cited by 14 publications

References 18 publications

Blunt prenatal trauma resulting in fetal epidural or subdural hematoma: case report and systematic review of the literature

Blunt prenatal trauma resulting in fetal epidural or subdural hematoma: case report and systematic review of the literature

Are Peripapillary Intrascleral Hemorrhages Pathognomonic for Abusive Head Trauma?*

A case for an in utero etiology of chronic SDH/effusions of infancy

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