Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by McNeely, P.D. Articles by Farmer, J.-P. Search for Related Content PubMed PubMed Citation Articles by McNeely, P.D. Articles by Farmer, J.-P.

American Journal of Neuroradiology 27:1725-1728, September 2006
© 2006 American Society of Neuroradiology

PEDIATRICS

Subdural Hematomas in Infants with Benign Enlargement of the Subarachnoid Spaces Are Not Pathognomonic for Child Abuse

P.D. McNeely^a, J.D. Atkinson^b, G. Saigal^c, A.M. O’Gorman^c and J.-P. Farmer^b

^a Division of Neurosurgery, Department of Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
^b Division of Neurosurgery, Department of Surgery, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada
^c Department of Radiology, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada

Address correspondence to P. Daniel McNeely, MD, FRCSC, Division of Neurosurgery, IWK Health Centre, 5850 University Ave, P.O. Box 9700, Halifax, NS, B3K 6R8 Canada; e-mail: dmcneely{at}dal.ca

BACKGROUND AND PURPOSE: Patients who have benign enlargement of the subarachnoid spaces (BESS) have long been suspected of having an increased propensity for subdural hematomas either spontaneously or as a result of accidental injury. Subdural hematomas in infants are often equated with nonaccidental trauma (NAT). A better understanding of the clinical and imaging characteristics of subdural hematomas that occur either spontaneously or as a result of accidental trauma may help distinguish this group of patients from those who suffer subdural hematomas as a result of NAT. The purpose of this study is to describe the clinical and imaging characteristics of subdural hematomas that occur either spontaneously or as a result of accidental injury in infants with BESS.

METHODS: We conducted a retrospective review of all patients with BESS complicated by subdural hematomas evaluated at a single institution from 1998 to 2004. Data concerning the patient’s clinical presentation, physical findings, imaging, and management are described.

RESULTS: During the study period, 7 patients with BESS complicated by subdural hematoma were identified. Their mean age at identification of the subdural hematoma was 7.4 months of age. In 5 cases, there was no recognized trauma before identification of the subdural hematoma. In 3 cases, baseline CT or MR imaging was available, showing prominent subarachnoid spaces without any evidence of subdural hemorrhage.

CONCLUSION: Although suspicious for NAT, subdural hematomas can occur in children either spontaneously or as a result of accidental trauma. Caution must be exercised when investigating for NAT based on the sole presence of subdural hematomas, especially in children who are otherwise well and who have BESS.

This article has been cited by other articles:

				V.J. Rooks, J.P. Eaton, L. Ruess, G.W. Petermann, J. Keck-Wherley, and R.C. Pedersen Prevalence and Evolution of Intracranial Hemorrhage in Asymptomatic Term Infants AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1082 - 1089. [Abstract] [Full Text] [PDF]