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Dias MS, Thamburaj K. Neuroradiologic timing of intracranial hemorrhage in abusive head trauma. Pediatr Radiol 2021; 51:911-917. [PMID: 33999236 DOI: 10.1007/s00247-020-04824-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/22/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
Determining the timing of intracranial injuries in general, and abusive head trauma (AHT) in particular, is important to the care of children with traumatic brain injury. Additionally, identifying the time of the injury provides important information as to who might have, and who did not, inflict the trauma. Understanding the appearance and evolution of intracranial findings on neuroimaging has been an important factor in assessing the time of the injury. However, a number of studies in the last two decades have both suggested greater uncertainty about the reliability of this process and advanced our knowledge in this area. In this review, the authors consider the biophysical factors that contribute to the appearance and evolution of intracranial hemorrhage and, in particular, subdural hemorrhage (SDH). The traditional view of SDH is predicated largely on prior studies of intracerebral hemorrhage, although a number of variables make this comparison untenable. Moreover, more recent studies have suggested a number of factors that could alter the density (CT) or signal intensity (MRI) and produce mixed density/intensity SDH. These factors need to be considered in interpreting neuroimaging studies. A number of these recent studies evaluating serial neuroimaging in children with AHT have modified our understanding of intracranial hemorrhage and its evolution in this context. Taken together, the studies to date, having important limitations, provide only broad ranges over which to time injuries. The authors conclude that neuroimaging studies at this time are not likely, in isolation, to be able to accurately pinpoint a specific time of injury; rather, neuroimaging can only provide a range of possible times and should instead be used as a means to supplement or corroborate timing based on clinical presentation and other imaging findings.
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Affiliation(s)
- Mark S Dias
- Department of Neurosurgery, Penn State Health College of Medicine, 30 Hope Drive, Suite 2750, Hershey, PA, 17033, USA.
- Department of Pediatrics, Penn State Health College of Medicine, Hershey, PA, USA.
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Wittschieber D, Karger B, Pfeiffer H, Hahnemann ML. Understanding Subdural Collections in Pediatric Abusive Head Trauma. AJNR Am J Neuroradiol 2019; 40:388-395. [PMID: 30523144 PMCID: PMC7028666 DOI: 10.3174/ajnr.a5855] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/16/2018] [Indexed: 11/07/2022]
Abstract
Life-threatening physical abuse of infants and toddlers is frequently correlated with head injuries. A common variant of the abusive head trauma is the shaken baby syndrome. The present review article sheds light on subdural collections in children with abusive head trauma and aims at providing a recent knowledge base for various medical disciplines involved in diagnostic procedures and legal proceedings. To this end, the different subdural collection entities are presented and illustrated. The pathophysiologic background is explained. Differential and age-diagnostic aspects are discussed and summarized by tabular and graphic overviews. Two problematic constellations frequently occurring during initial CT investigations are evaluated: A mixed-density subdural collection does not prove repeated trauma, and hypodense subdural collections are not synonymous with chronicity. The neuroradiologic analysis and assessment of subdural collections may decisively contribute to answering differential diagnostic and forensic questions. In addition to more reference data, a harmonization of terminology and methodology is urgently needed, especially with respect to age-diagnostic aspects.
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Affiliation(s)
- D Wittschieber
- From the Institute of Legal Medicine (D.W., B.K., H.P.), University Hospital Münster, Münster, Germany
- Institute of Legal Medicine (D.W.), Friedrich Schiller University Jena, Jena, Germany
| | - B Karger
- From the Institute of Legal Medicine (D.W., B.K., H.P.), University Hospital Münster, Münster, Germany
| | - H Pfeiffer
- From the Institute of Legal Medicine (D.W., B.K., H.P.), University Hospital Münster, Münster, Germany
| | - M L Hahnemann
- Institute of Diagnostic and Interventional Radiology and Neuroradiology (M.L.H.), University Hospital Essen, Essen, Germany
- Department of Neuroradiological Diagnostics and Intervention (M.L.H.), Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Chmieliauskas S, Anuzyte JS, Liucvaikyte J, Laima S, Jurolaic E, Rocka S, Fomin D, Stasiuniene J, Jasulaitis A. Importance of effusion of blood under the dura mater in forensic medicine: A STROBE - compliant retrospective study. Medicine (Baltimore) 2018; 97:e12567. [PMID: 30278562 PMCID: PMC6181611 DOI: 10.1097/md.0000000000012567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Subdural hemorrhage is commonly associated with mechanical brain injury and has a correspondingly high mortality rate. Subdural hematomas may immediately provoke symptoms or may be initially asymptomatic, with further symptoms evolving rapidly and fatally.The data regarding forensic autopsy of victims were obtained from The State Forensic Medicine Service of Lithuania between the years 2013 and 2016. A retrospective study was performed including 110 patients, whose cause of death was subdural hemorrhage. 95% confidence intervals were calculated.It was calculated, that in cases of sudden death, after subdural hemorrhage was diagnosed, a higher concentration of ethyl alcohol in blood (mean 2.22 ± 1.3%) demanded a smaller amount of blood under the dura matter (mean 81.6 ± 60.5 g) in order for the patient to die. It was also noted that hospitalized patients with subdural hemorrhage had a smaller concentration of blood ethyl alcohol (mean 1.33 ± 1%) and a larger amount of blood under the dura (mean 135.6 ± 82.9 g).Due to the toxic effect of ethyl alcohol, even a small amount (81.6 ± 60.5 g) of blood under the dura matter can determine a sudden death.
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Affiliation(s)
- Sigitas Chmieliauskas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
- State Forensic Medicine Service
| | - Joginte Saule Anuzyte
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
| | - Julita Liucvaikyte
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
| | - Sigitas Laima
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
- State Forensic Medicine Service
| | | | - Saulius Rocka
- Department of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania
| | - Dmitrij Fomin
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
- State Forensic Medicine Service
| | - Jurgita Stasiuniene
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
| | - Algimantas Jasulaitis
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
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Lindberg DM, Wood JN, Campbell KA, Scribano PV, Laskey A, Leventhal JM, Pierce MC, Runyan DK. Research priorities for a multi-center child abuse pediatrics network - CAPNET. CHILD ABUSE & NEGLECT 2017; 65:152-157. [PMID: 28161656 PMCID: PMC5774239 DOI: 10.1016/j.chiabu.2017.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/21/2017] [Indexed: 05/30/2023]
Abstract
Although child maltreatment medical research has benefited from several multi-center studies, the new specialty of child abuse pediatrics has not had a sustainable network capable of pursuing multiple, prospective, clinically-oriented studies. The Child Abuse Pediatrics Network (CAPNET) is a new multi-center research network dedicated to child maltreatment medical research. In order to establish a relevant, practical research agenda, we conducted a modified Delphi process to determine the topic areas with highest priority for such a network. Research questions were solicited from members of the Ray E. Helfer Society and study authors and were sorted into topic areas. These topic areas were rated for priority using iterative rounds of ratings and in-person meetings. The topics rated with the highest priority were missed diagnosis and selected/indicated prevention. This agenda can be used to target future multi-center child maltreatment medical research.
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Affiliation(s)
- Daniel M Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, 12401 E. 17th Ave. Mailstop B-215, Aurora, CO 80045, United States.
| | - Joanne N Wood
- Division of General Pediatrics and PolicyLab, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Safe Place: Center for Child Protection and Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States.
| | - Kristine A Campbell
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.
| | - Philip V Scribano
- Safe Place: Center for Child Protection and Health, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States.
| | - Antoinette Laskey
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.
| | - John M Leventhal
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States.
| | - Mary Clyde Pierce
- Department of Pediatrics, Feinberg School of Medicine Northwestern University, United States.
| | - Desmond K Runyan
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, University of Colorado School of Medicine, 12401 E. 17th Ave. Mailstop B-215, Aurora, CO 80045, United States.
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Rao MG, Singh D, Khandelwal N, Sharma SK. Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study. J Clin Diagn Res 2016; 10:HC01-5. [PMID: 27190831 DOI: 10.7860/jcdr/2016/17207.7644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/18/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Determination of post-traumatic interval remains one of the foremost important goals of any forensic investigation related to human crimes. 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. AIM The purpose of this study was to determine the post-traumatic interval of Subdural Haemorrhage (SDH) based on Hounsfield Unit measurements (HU) on Computed Tomography (CT) in surviving victims of head injury. MATERIALS AND METHODS The study included a total of 100 cases of closed head injury with subdural haemorrhage. The Post-traumatic Time Interval (PTI) varied from 0.5 hours to a maximum of 249 hours, with a mean of 54.2 hours. 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.
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Affiliation(s)
- Murali Gundu Rao
- Assistant Professor, Department of Forensic Medicine, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Dalbir Singh
- Professor and Head, Department of Forensic Medicine, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Niranjan Khandelwal
- Professor and Head, Department of Radio-diagnosis & Imaging, Post Graduate Institute of Medical Education and Research , Chandigarh, India
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