Subdural Hemorrhage in Abusive Head Trauma: Imaging Challenges and Controversies

Overview Overview Subdural hematomas SDH are 1 of the 3 types of extra-axial intracranial hemorrhages along with subarachnoid and epidural hemorrhages and usually occur as a result of trauma. Deceleration injuries are often the cause of subdural bleeding from rupturing of veins via a shearing mechanism. Other entities, such as child abuse and ventricular decompression, also can result in subdural bleeding, and spontaneous hemorrhages may occur in patients receiving anticoagulants or patients with a coagulopathy condition. Compression of a dural sinus does not directly cause a subdural hematoma, although compression may result in a venous infarction. Chronic subdural hematoma is more common in elderly individuals because of the age-associated decrease in brain volume and the increase in venous fragility. Some hematomas can grow large enough to result in herniation of cerebral tissue. Before computed tomography CT scanning and magnetic resonance imaging MRI technology, subdural hematomas were diagnosed only on the basis of this mass effect, which was depicted as displacement of the blood vessels on angiograms or as a calcified pituitary gland on skull radiographs. The advent of CT scan and MRI studies has made the diagnosis of even small hemorrhages routine see the image below. CSH images may appear as hypodense, isodense, hyperdense, or mixed density.

Common Illness

CONTACT Subdural Hematoma A subdural hematoma Subdural hematoma SDH is a form of traumatic brain injury in which blood gathers between the dura the outer protective covering of the brain and the arachnoid the middle layer of the meninges. Unlike in epidural hematomas, which are usually caused by tears in arteries, subdural bleeding usually results from tears in veins that cross the subdural space.

This bleeding often separates the dura and the arachnoid layers.

The authors report cases in which acute subdural hematomas resulting from closed head injury were surgically treated. The mortality rate was 48% for those treated within 24 hours of injury and 45% for those treated within 72 hours.

February 1, Child abuse is a relatively common problem in our society. S it is estimated that 4 million children a year are abused in some manner. At least two thousand children die as a result of this abuse. This overview focusses on the role of diagnostic imaging in depicting the findings that are specific for child abuse. Awareness of the radiologist is essential in finding these skeletal and CNS injuries in order to document child abuse, to stop further abuse and to protect siblings.

The term shaken infant syndrome probably best describes the classic pattern of injuries. The child is held around the chest and violently shaken back and forth. This causes the extremities and the head to flail back and forth in a whiplash movement. Intracranial injury occurs as a result of severe angular acceleration, deceleration and direct impact as the head strikes a solid object. The chest is compressed resulting in rib fractures.

Arms and legs move about in a whiplash movement resulting in the typical ‘corner’ or ‘bucket-handle’-fractures in the metaphyseal region. Role of the Radiologist The ability to identify child abuse constitutes an important concern to those involved in the medical care of children.

Intracranial hemorrhage

The first bold letter in each pair denotes the typical t1 signal finding, while the second denotes the t2 signal change. For those that find it difficult to memorise the mnemonic above an alternative is found below which uses full word pairs. Acute, subacute hemorrhage as well as hemorrhagic components of. Ebisu t, naruse s, horikawa y, tanaka c, higuchi t. To date, this training has been. Compounds or the polymer stent coating or its individual components.

Age determination of subdural hematomas is important to relate radiological findings to the clinical history presented by the caregivers. In court this topic is relevant as dating subdural hematomas can lead to identification of a suspect.

Hearing loss or hearing ringing tinnitus Blurred Vision Causes[ edit ] Subdural hematomas are most often caused by head injury , when rapidly changing velocities within the skull may stretch and tear small bridging veins. Subdural hematomas due to head injury are described as traumatic. Much more common than epidural hemorrhages , subdural hemorrhages generally result from shearing injuries due to various rotational or linear forces.

Subdural hematoma is also commonly seen in the elderly and in alcoholics, who have evidence of cerebral atrophy. Cerebral atrophy increases the length the bridging veins have to traverse between the two meningeal layers, hence increasing the likelihood of shearing forces causing a tear. It is also more common in patients on anticoagulants or antiplatelet drugs , such as warfarin and aspirin. Patients on these medications can have a subdural hematoma after a relatively minor traumatic event.

A further cause can be a reduction in cerebral spinal fluid pressure which can create a low pressure in the subarachnoid space, pulling the arachnoid away from the dura mater and leading to a rupture of the blood vessels. Risk factors[ edit ] Factors increasing the risk of a subdural hematoma include very young or very old age. As the brain shrinks with age, the subdural space enlarges and the veins that traverse the space must travel over a wider distance, making them more vulnerable to tears.

This and the fact that the elderly have more brittle veins make chronic subdural bleeds more common in older patients. In juveniles, an arachnoid cyst is a risk factor for a subdural hematoma. Acute subdural haematoma is usually caused external trauma that creates tension in the wall of a bridging vein as it passes between the arachnoid and dural layers, i.

Traumatic Brain Injury

According to the unproven SBS hypothesis, shaking causes the brain to impact against the inside of the skull, causing widespread brain damage Diffuse Axonal Injury and ripping shearing the veins between the brain and skull bridging veins resulting in bleeding Subdural Hematoma in the “subdural spaces” in between and behind the eyes Retinal Hemorrhages. In fact, the exact cause–mechanism of action–of retinal hemorrhages remains unknown. The shaking hypothesis evolved in the worst possible way, scientifically speaking.

Caffey read about an incident where an enormous, muscle-bound nurse admitted to shaking numerous infants and babies in her care, three of whom later died, although it wasn’t proven that shaking was the cause of death. Normally, to prove a hypothesis, other causes of the same symptoms must be identified Differential Diagnosis and eliminated.

In terms of dating the subdural hematomas, Dr. Hoffman-Rosenfeld characterized them as “subacute to chronic.” Dr. Hoffman-Rosenfeld clarified that the dating of subdural hematomas is not an exact science, but identified that “subacute to chronic” means “a few weeks to many weeks or even months.”.

Persistent vomiting Exams and Tests Get medical help right away after a head injury. Older adults should receive medical care if they show signs of memory problems or mental decline, even if they don’t seem to have an injury. Treatment A subdural hematoma is an emergency condition. Emergency surgery may be needed to reduce pressure within the brain. This may involve drilling a small hole in the skull to drain any blood and relieve pressure on the brain. Large hematomas or solid blood clots may need to be removed through a procedure called a craniotomy , which creates a larger opening in the skull.

Medicines that may be used depend on the type of subdural hematoma, how severe the symptoms are, and how much brain damage has occurred. Diuretics water pills and corticosteroids to reduce swelling Anti-seizure drugs to control or prevent seizures Outlook Prognosis Outlook depends on the type and location of head injury, the size of the blood collection, and how soon treatment is started. Acute subdural hematomas have high rates of death and brain injury. Chronic subdural hematomas have better outcomes in most cases.

Symptoms often go away after the blood collection is drained. Physical therapy is sometimes needed to help the person get back to their usual level of functioning.

Doctor Sued Over Late Diagnosis of Subdural Hematoma

What is an Acute Subdural Hematoma? These veins rupture when a head injury suddenly jolts or shakes the brain. Traumatic acute SDHs are among the most lethal of all head injuries. SDHs are seen in 10 percent to 20 percent of all traumatic brain injury cases and occur in up to 30 percent of fatal injuries. Treatment SDHs greater than 1 cm at the thickest point generally require rapid surgical treatment.

Smaller SDHs may not require surgery.

We would, however, like to comment on the issue of dating the causal episode in cases of SDHy. The authors offered 2 possible concepts to explain SDHy formation: delayed formation as an intermediate stage of a subdural hematoma and rapid formation from a tear in the arachnoid membrane.

Hearing loss or hearing ringing tinnitus Blurred Vision Causes[ edit ] Subdural hematomas are most often caused by head injury , when rapidly changing velocities within the skull may stretch and tear small bridging veins. Subdural hematomas due to head injury are described as traumatic. Much more common than epidural hemorrhages , subdural hemorrhages generally result from shearing injuries due to various rotational or linear forces.

Subdural hematoma is also commonly seen in the elderly and in alcoholics, who have evidence of cerebral atrophy. Cerebral atrophy increases the length the bridging veins have to traverse between the two meningeal layers, hence increasing the likelihood of shearing forces causing a tear. It is also more common in patients on anticoagulants or antiplatelet drugs , such as warfarin and aspirin.

Verdasco and ivanovic dating

Symptoms of physical abuse in children, especially infants, are often nonspecific and may overlap with numerous other clinical conditions. Therefore, radiologists play a key role in identifying imaging findings to make the diagnosis of physical child abuse. Although many injury patterns may be seen with both accidental and nonaccidental trauma, there are some characteristic findings and injury patterns of abuse that should be recognized by radiologists who interpret pediatric imaging studies.

This review covers the characteristic imaging manifestations of child abuse, as well as diagnostic pearls, pitfalls, and limitations associated with skeletal, intracranial, spinal, and abdominal injuries.

Subdural hematoma is defined as an extra-axial collection of blood products in the subdural space, which is a potential space between the arachnoid and dura mater. The dura mater is the outermost meningeal layer covering the brain parenchyma.

The estimation of time since injury in cases of subdural haemorrhage has been studied only by a few investigators on the histological and radiological front. Materials and Methods The study included a total of cases of closed head injury with subdural haemorrhage. Results Statistically significant results were obtained between the HU measurements of the SDH and the post-traumatic intervals and were found to be statistically significant. A rough attempt was made to determine the effect of haematoma volume on attenuation and was found out to be statistically insignificant.

Conclusion The density of the subdural haematoma decreases with increase in the post-traumatic interval that concurs with the limited number of studies being conducted in the past. We concluded that further sorting of cases could be done according to its age with additional research and uniformity in the methodology.

Attenuation coefficient, Computed tomography, Post-traumatic interval, Subdural haemorrhage, Volume Introduction Subdural Haemorrhage SDH is a form of brain haemorrhage in which there is a collection of blood between the dura and the arachnoid layers of the meninges. It is usually associated with mechanical brain injury [ 1 ]. The occurrence of subdural haemorrhage may or may not be associated with any visible injury to scalp, skull or brain.

subdural hematoma

We definitely agree that any pericerebral subdural collections—that is, hygromas or chronic subdural hematomas true evolution within a few weeks of a subdural hematoma —should prompt pediatricians to strongly consider AHT if all other classic etiologies have been ruled out. We would, however, like to comment on the issue of dating the causal episode in cases of SDHy. The authors offered 2 possible concepts to explain SDHy formation: As a result, the mixed-attenuation pattern cannot be used to date the causal event.

Modified from Bullock et al, 2 Traumatic subdural hematoma is a risk factor for patients who sustain a head trauma and are taking anticoagulation medications.

This refers to an area of localized injury that may cause pressure within the brain. The most common mass lesions related to TBI are hematomas and contusions. A hematoma is a blood clot within the brain or on its surface. Hematomas may occur anywhere within the brain. An epidural hematoma is a collection of blood between the dura mater the protective covering of the brain and the inside of the skull. A subdural hematoma is a collection of blood between the dura mater and the arachnoid layer, which sits directly on the surface of the brain.

A cerebral contusion is bruising of brain tissue. When examined under a microscope, cerebral contusions are comparable to bruises in other parts of the body.

‘Jeopardy!’ Host Alex Trebek Recovering From Brain Surgery

Journal Subdural Hematoma A subdural hematoma is a serious, and potentially life-threatening, head injury that occurs when blood collects between the brain’s cover known as the dura and its surface. A subdural hematoma is a serious, and potentially life-threatening, head injury that occurs when blood collects between the brain’s cover known as the dura and its surface. A subdural hematoma is not something you can diagnose at home, though you may suspect you have one based on symptoms.

Any head injury is a medical emergency that has the potential to become life-threatening. So if you have recently suffered a blow to the head, have signs of a stroke, or have experienced a change in consciousness or personality, don’t delay seeking medical help. Prompt medical assistance is the single best predictor of recovery from any head injury, including subdural hematomas.

A subdural hematoma is a collection of blood between the dura mater and the arachnoid layer, which sits directly on the surface of the brain. A cerebral contusion is bruising of brain tissue. When examined under a microscope, cerebral contusions are comparable to bruises in other parts of the body.

The Amanda Truth Project: Bleeding between the brain and skull subdural hematoma 2. Bleeding behind the eye bilateral retinal hemorrhaging 3. Ayub Ommaya ‘s article “Whiplash. John Caffey from the United States picked up Guthkelch’s observations and continued on with his own studies. She died soon after. In the past decade, that consensus has begun to come undone.

A small but growing number of doctors warn that there can be alternate explanations — infections or bleeding disorders, for example — for the triad of symptoms associated with shaken-baby syndrome. Across the country, the group of lawyers that has succeeded in exonerating hundreds of people based on DNA evidence is now mounting 20 to 25 appeals of shaken-baby convictions.

Ommaya took more than 50 rhesus monkeys and strapped each one into a chair mounted on wheels, leaving their heads unsupported. He placed the chair on a foot-long track, and an air-powered piston sent the monkeys zooming into a wall. Fifteen emerged with some kind of cerebral hemorrhage. Eight of those also had injuries to the brain stem or cervical cord.

Woman’s Old Growth Finally Gets Popped (REVIEW)