Patient Presentation A 4-month-old female was referred to the pediatric intensive care unit after she presented with 9 days of emesis. She initially began vomiting once per day but this increased to several times per day over days. She was seen by a local health care provider who admitted her locally. She improved with intravenous fluid by the next day and was discharged home. Three days later she began to have emesis again and her mother noticed her crossing her eyes.
They also had no concerns about the childcare provider or family friends who had baby-sat for them. The diagnosis of bilateral subdural hematomas of unknown cause with increased intracranial pressure was made. The team also noted that under good constant supervision, which this infant needed because of her age, any significant trauma would be observed by a caretaker.
As there is no disclosure of any incident there was a concern for non-accidental head trauma.
Are not dating of subdural hematoma think, that you
The Department of Human Services was contacted when the infant was admitted and they investigated the social situation. The neurosurgeons would then aspirate the subdural fluid through the anterior fontanelle with relief of the tension and stopping of the emesis.
The patient underwent 3 aspirations. She was discharged after 6 days when she had stable head circumference measurements, physical examinations of her fontanelle and eyes, and no emesis. She was discharged to foster care along with her older sibling pending further investigation by the Department of Human Services and court action.
Figure 55 - Axial T1 leftT2 center and FLAIR right weighted images from an MRI scan of the brain performed without intravenous contrast obtained at the same level as the previously performed CT scan of the brain better demonstrates the large, bilateral chronic subdural hematomas with the linear focus of acute subdural hematoma in the frontal ct of the left chronic subdural hematoma.
Figure 54 - Axial image of a CT scan of the brain performed without intravenous contrast shows large, bilateral, low density extraxial fluid collections that are subdural hematomas.
BACKGROUND: After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (SDH), the magistrates ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of NAHI. We aimed to develop an SDH dating system applicable to Cited by: 1. A subdural hematoma is a collection of blood that forms on the surface of the brain. The blood may press against the brain and damage the tissue. A subdural hematoma can be life-threatening. A chronic subdural hematoma may happen in older people after a minor head injury. Eating is not only a basic need but also a pleasure. Eating our favourite dishes and discovering new cuisines makes us all happy in life, it brings us joy and gives us a sense of security. Communicating and making daily connection with people is also vital to our existence. Friends, family, colleagues, clients and travellers all have something in common: we all are connected through food.
In the frontal ct of the left chronic subdural hematoma a linear focus of high density is seen and this represents an area of acute subdural hematoma within the chronic subdural hematoma. Another acute subdural hematoma was noted in the left posterior fossa not pictured. Birth trauma should be considered as a potential cause of subdural hematomas.
There can dating of subdural hematoma speaking
This child was delivered by caesarean section and therefore this is not a possibility. It is possible that this child was shaken or shaken and then slammed against a softer surface sometime in the past.
At the time of injury, she might have had other signs of injury such as retinal hemorrhages or bruising of the skin that were not apparent when the subdural hematomas were identified. Fractures, especially fractures at different stages of healing, posterior rib fractures and metaphyseal fractures are more likely to be associated with non-accidental trauma.
Incidental findings such as rib fractures can be the presentation of non-accidental trauma. A second skeletal survey was conducted to look for occult fractures that might have been missed on the original skeletal survey, which ruled out any skeletal injury in this child.
Subdural Hematoma Treatment
Learning Point Timing of injuries may assist the health care providers treating the patient, e. Timing may also assists child protection legal system professionals such as social workers, police officers, lawyers and judges.
However, in some cases, especially those presenting with chronic findings, it maybe difficult to precisely time injuries exactly owing to many factors. Factors that can affect the imaging appearance include hemoglobin level at the time of bleeding, location of the bleeding brain parenchymal versus extraaxialoxygen status of hemoglobin, intracellular versus extracellular location of hemoglobin, single versus recurrent bleeding, operative intervention, and obviously time from injury to imaging, to name a few.
Because of this, timing of subdural hematomas should be done based on utilizing imagining findings combined with taking into consideration the onset, progression and severity of clinical findings. There is little of reliable data for the dating of extraaxial hemorrhages such as subdural hemorrhages. There is data on timing of brain parenchymal hemorrhages using magnetic resonance imaging.
This is often grouped according to the following information below, but note timing in only approximate. Questions for Further Discussion 1.
Seems dating of subdural hematoma really
What is the radiographic appearance of acute and healing fractures and what timing is associated with each stage? What legal and ethical responsibilities does a health care professional have for protecting a minor?
Locally, how do the medical and legal systems work together to coordinate care and protection of a minor? To view current news articles on this topic check Google News.
To view images related to this topic check Google Images. Ophthalmology ; Huisman, TAGM.
Dec 03, Because of this, timing of subdural hematomas should be done based on utilizing imagining findings combined with taking into consideration the onset, progression and severity of clinical findings. There is little of reliable data for the dating of extraaxial hemorrhages such as subdural . Dating is generally done on subdural hematoma (SDH) histopathology . But in few case, the clot or the dura are not present in the seals because of the fluidity of the hematoma or not. Jul 13, A subdural hematoma occurs when a vein ruptures between your skull and your brain's surface. Acute subdural hematomas If you sustain a major .
Eur Radiol. J Neurosurg. Scaletta T.
Objectives: To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans. Methods: We performed a systematic review in MEDLINE, EMBASE and Cochrane to search for articles that described the appearance of SDHs on CT or MRI in relation to time between trauma and scanning. Two researchers independently screened the articles, assessed methodological quality and Cited by:
Subdural Hematoma. Wager AL.
Intracranial hemorrhage in asymptomatic neonates: prevalence on MR images and relationship to obstetric and neonatal risk factors.
Internet Stroke Center. Medical Knowledge An investigatory and analytic thinking approach to the clinical situation is demonstrated.
Dating of subdural hematoma
Basic and clinically supportive sciences appropriate to their discipline are known and applied. Practice Based Learning and Improvement Methods and results: We studied a retrospective multicenter collection of infants who died between the ages of 0 and 36 months, diagnosed with SDH by forensic pathological examination and with known posttraumatic interval PTI.
Two pathologists assessed blindly and independently 12 histomorphological criteria relating to the clot and 14 relating to the dura mater in 73 victims 31 girls, 42 boys whose median age was 3.
Histopathological changes were significantly correlated with PTI for the appearance of red blood cells RBCs and the presence or absence of siderophages, and regarding the dura mater, the quantity of lymphocytes, macrophages, and siderophages; presence or absence of hematoidin deposits; collagen and fibroblast formation; neomembrane thickness; and presence or absence of neovascularization.
Dating systems for SDH in adults are not applicable to infants. Notably, neomembrane of organized connective tissue is formed earlier in infants than in adults.
Conclusion: Our dating system improves the precision and reliability of forensic pathological expert examination of NAHI, particularly for age estimation of SDH in infants.