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Research ArticlePEDIATRICS

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

P.D. McNeely, J.D. Atkinson, G. Saigal, A.M. O’Gorman and J.-P. Farmer
American Journal of Neuroradiology September 2006, 27 (8) 1725-1728;
P.D. McNeely
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J.D. Atkinson
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G. Saigal
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A.M. O’Gorman
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J.-P. Farmer
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Article Figures & Data

Figures

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  • Fig 1.
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    Fig 1.

    Axial fluid-attenuated inversion recovery MR image showing prominent CSF equivalent subarachnoid spaces in both frontal regions. No subdural hemorrhage is noted.

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    Fig 2.

    Axial fluid-attenuated inversion recovery MR of same patient as in Fig 1 done 19 days later (patient remained hospitalized) now showing an isointense area in the left subdural space, consistent with a hematoma. The subarachnoid CSF space is seen clearly separate from the overlying subdural space containing the hematoma.

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    Fig 3.

    Axial CT scan showing prominent subarachnoid spaces in both frontal regions.

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    Fig 4.

    Axial fluid-attenuated inversion recovery MR sequence showing thin bilateral subdural hematomas that are seen separate from the underlying subarachnoid space.

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    Fig 5.

    Axial T2-weighted MR image also showing the thin bilateral subdural hematomas.

Tables

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  • Clinical and imaging characteristics of patients*

    PatientAge at Diagnosis of Subdural Hematoma (mo)/SexHead Circumference at Subdural Hematoma Diagnosis (cm)Presenting Signs and SymptomsImaging FindingsTreatment
    18.5/M47.5 (normal)Bulging fontanelle, nausea, and lethargy4-mm-thick right acute SDHObservation alone
    23.9/M44 (macrocephalic)Macrocephalic but otherwise asymptomatic; HC >98th percentile corrected for age; normal fundi; developmentally normalThin SDH present bilaterally measuring 5 mm thickObservation alone
    34.7/F45.8 (macrocephalic)Macrocephalic, bulging fontanelle; irritable, spasticityBilateral 18-mm-thick chronic SDHs
    1. Bilateral subdural–peritoneal shunts

    2. Bifrontal craniotomy

    417.8/M50 (normal)Fall from own height causing linear right parietal skull fracture and bilateral SDHs; returned 6 weeks later with irritability and bulging fontanelleBilateral subacute SDHs measuring 10 mm on right and 9 mm on left, and right parietal linear nondisplaced skull fracture
    1. Burrhole drainage 6 weeks following trauma

    2. Required bilateral subdural peritoneal shunts 12 weeks after the trauma

    53.6/M45.9 (macrocephalic)Macrocephalic but otherwise asymptomatic; fundus normalProminent pericerebral fluid spaces noted on referral for evaluation of macrocephaly; MRI 1 week later showed thin bilateral subdural hemorrhage with membranes (11 mm on right and 18 mm on left)
    1. Bilateral burrhole drainage 19 days following referral

    2. Left subdural peritoneal shunt inserted 1 week later

    66.3/FNot recordedFever and upper respiratory tract infection symptoms, lethargy, and spasticityInitial MRI showed prominent SAS; second MRI done during hospitalization showed an 8-mm left subdural hematomaObservation alone
    77/M45.5Motor vehicle crash— Patient was in a proper car seat, not ejected; Presented with decreased level of consciousness, vomiting, and respiratory pauses, and was therefore intubated and admitted to an intensive care unit. Found to have retinal and preretinal hemorrhages on fundoscopyInitial CT showed an 11-mm-thick left acute SDH with a 4-mm midline shift and pericerebral fluid collections. MRI done in the days that followed was interpreted as showing SDHs of various ages in multiple compartments including the perifalcine regionNo surgical intervention for the subdural hematoma; developed seizures that were treated with carbamazepine
    • HC indicates head circumference; SDH, subdural hematoma; SAS, subarachnoid space.

    • * Patients younger than 18 months of age evaluated at Montreal Children’s Hospital between 1998 and 2004 who were found to have BESS and a concomitant subdural hematoma on imaging. NAT was ruled out in every case.

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American Journal of Neuroradiology: 27 (8)
American Journal of Neuroradiology
Vol. 27, Issue 8
September 2006
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Subdural Hematomas in Infants with Benign Enlargement of the Subarachnoid Spaces Are Not Pathognomonic for Child Abuse
P.D. McNeely, J.D. Atkinson, G. Saigal, A.M. O’Gorman, J.-P. Farmer
American Journal of Neuroradiology Sep 2006, 27 (8) 1725-1728;

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Subdural Hematomas in Infants with Benign Enlargement of the Subarachnoid Spaces Are Not Pathognomonic for Child Abuse
P.D. McNeely, J.D. Atkinson, G. Saigal, A.M. O’Gorman, J.-P. Farmer
American Journal of Neuroradiology Sep 2006, 27 (8) 1725-1728;
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  • Prevalence of Subdural Collections in Children with Macrocrania
  • External hydrocephalus and subdural bleeding in infancy associated with transplacental anti-Ro antibodies
  • Shaken Baby Syndrome: Diagnosis and Treatment
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