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

Zahl, Sverre Morten; Mack, Julie; Rossant, Cyrille; Squier, Waney; Wester, Knut

doi:10.1111/apa.15908

Cited by 7 publications

(8 citation statements)

References 79 publications

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“…[3][4][5][6][7] Therefore, the veins in the subdural part are more fragile than the subarachnoid space. 26 The present study in rat pups showed that spinal anesthesia caused both subdural hematoma and epidural hematoma. Epidural and subdural hematoma occurred following lumbar puncture in cases of cerebral aneurysm, cerebral tumor, and cerebrovascular accidents.…”

Section: Discussionmentioning

confidence: 50%

Epidural and subdural hematoma following spinal anesthesia in infants rat model

et al. 2022

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The aim of this study was to assess the epidural and subdural hematoma following spinal anesthesia in infants’ rat model. We investigated during 10, 15, and 20 days’ rats in group 1: intrathecal injection of bupivacaine 3.75 mg/kg (n = 7); group 2: received 37.5 μl midazolam 0.1% intrathecal with 37.5μl fentanyl 0.005% (no=7); injected into group 3 methylene blue 1 mg/ml (No. 7). Rats were exposed to spinal anesthesia in infancy and rotarod in motor function in adulthood. Histological evaluation and tissue extraction were also performed after the treatment and magnetic resonance imaging (MRI) of the head. MRI of the head of all rat pups that showed similar symptoms were performed. 4 rat pups showed the symptoms of hematoma Group1: small acute subdural hematoma at the left posterior temporal-parietal junction (PTPJ) and group 2 (one: right temporal epidural hematoma, two: Small acute subdural hematoma in the right temporomandibular area, and three: frontal-temporal-parietal-occipital hematoma). the rat pup that had epidural hematoma died 6 hours later. Finally, in the first group, one rat and the second group three rats showed hematoma symptoms. For these three rats, a histopathologic study was performed and indicate the presence of small acute subdural hematoma at the left posterior temporal-parietal junction, right temporal epidural hematoma, and frontal-temporal-parietal-occipital hematoma. In summary, because subdural or epidural hematoma of the skull can have serious consequences, differential diagnosis is very important for pain after spinal anesthesia.

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Section: Discussionmentioning

confidence: 50%

Epidural and subdural hematoma following spinal anesthesia in infants rat model

et al. 2022

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“…We agree absolutely with Donaruma et al that “Another point demanding clarification is interpreting venous thrombosis as representative of vascular trauma.” 1 This clarification was the point of our article 2 …”

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confidence: 86%

“…1 This clarification was the point of our article. 2 Our article is based on data acquired by review of the literature concerning the validity of the hypothesis that thrombosis of bridging veins (BV) is a marker of rupture and abuse; an opinion would not require such a factual basis.…”

Section: Demanding Clarification That Venous Thrombosis Is Representa...mentioning

confidence: 99%

Demanding clarification that venous thrombosis is representative of vascular trauma

Zahl¹,

Mack

Rossant

et al. 2021

Acta Paediatrica

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“…18,42,79,85 Zahl et al assert that thrombosis is not a marker of BV rupture in infants with alleged AHT. 86 Rambaud reports BV ruptures from autopsies. 49 In the radiologic study by Krasnokutsky CVST/BV thrombosis from trauma did not correlate with trauma severity.…”

Section: Bv Rupturementioning

confidence: 99%

Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants

Vaslow

2021

Neuroradiol J

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For infants presenting with subdural hemorrhage, retinal hemorrhage, and neurological decline the “consensus” opinion is that this constellation represents child abuse and that cerebral venous sinus thrombosis and cortical vein thrombosis is a false mimic. This article contends that this conclusion is false for a subset of infants with no evidence of spinal, external head, or body injury and is the result of a poor radiologic evidence base and misinterpreted data. Underdiagnosis of thrombosis is the result of rapid clot dissolution and radiologic under recognition. A pre-existing/chronic subdural hemorrhage predisposes to development of venous sinus thrombosis/cortical vein thrombosis, triggered by minor trauma or an acute life-threatening event such as dysphagic choking, variably leading to retinal and subdural hemorrhages and neurologic decline. These conclusions are based on analysis of the neuroradiologic imaging findings in 11 infants, all featuring undiagnosed cortical vein or venous sinus thrombosis. Subtle neuroradiologic signs of and the mechanisms of thrombosis are discussed. Subarachnoid hemorrhage from leaking thrombosed cortical veins may be confused with acute subdural hemorrhage and probably contributes to the development of retinal hemorrhage ala Terson’s syndrome. Chronic subdural hemorrhage rebleeding from minor trauma likely occurs more readily than bleeding from traumatic bridging vein rupture. Radiologists must meet the challenge of stringent evaluation of neuro imaging studies; any infant with a pre-existing subdural hemorrhage presenting with neurologic decline must be assumed to have venous sinus or cortical vein thrombosis until proven otherwise.

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

Cited by 7 publications

References 79 publications

Epidural and subdural hematoma following spinal anesthesia in infants rat model

Epidural and subdural hematoma following spinal anesthesia in infants rat model

Demanding clarification that venous thrombosis is representative of vascular trauma

Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants

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