Abstract
In the first years of life, subdural haemorrhage (SDH) within the cranial cavity can occur through accidental and non-accidental mechanisms as well as from birth-related injury. This type of bleeding is the most common finding in victims of abusive head trauma (AHT). Historically, the most frequent cause of SDHs in infancy is suggested to be traumatic damage to bridging veins traversing from the brain to the dural membrane. However, several alternative hypotheses have been suggested for the cause and origin of subdural bleeding. It has also been suggested by some that bridging veins are too large to rupture through the forces associated with AHT. To date, there have been no systematic anatomical studies on infant bridging veins. During 43 neonatal, infant and young child post-mortem examinations, we have mapped the locations and numbers of bridging veins onto a 3D model of the surface of a representative infant brain. We have also recorded the in situ diameter of 79 bridging veins from two neonatal, one infant and two young children at post-mortem examination. Large numbers of veins, both distant from and directly entering the dural venous sinuses, were discovered travelling between the brain and dural membrane, with the mean number of veins per brain being 54.1 and the largest number recorded as 94. The mean diameter of the bridging veins was 0.93 mm, with measurements ranging from 0.05 to 3.07 mm. These data demonstrate that some veins are extremely small and subjectively, and they appear to be delicate. Characterisation of infant bridging veins will contribute to the current understanding of potential vascular sources of subdural bleeding and could also be used to further develop computational models of infant head injury.
Highlights
In early childhood, subdural haemorrhage (SDH) can occur through accidental and non-accidental mechanisms [1,2,3,4] as well as from birth-related trauma [5]
Infant and early childhood autopsies undertaken at Leicester Royal Infirmary between March 2014 and January 2017 as part of a regional paediatric autopsy service were included in this study (Table 1)
The vessels were typically observed in the parasagittal region close to the superior sagittal sinus (SSS), including vessels which appeared to be directly entering the sinus (Fig. 3a)
Summary
Subdural haemorrhage (SDH) can occur through accidental and non-accidental mechanisms [1,2,3,4] as well as from birth-related trauma [5]. The term abusive head trauma (AHT) is often used to include a pattern of injuries that are thought to occur through the inertial forces associated with a shaking event. Of these injuries, SDH is the most commonly observed feature and has been demonstrated in up to 92% of AHT cases [6]. Previous experimental research on head injuries has centred around animal and biomechanical models [13, 14] These studies have been used to estimate the amount of force required to tear bridging veins (which some authors state are large blood vessels [15, 16]) to magnitudes that would be far greater than that induced by inertial forces, such as those that
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