Abstract
BackgroundAcute subdural hematoma (ASDH) and chronic subdural hematoma (CSDH) in infants have been regarded as highly specific for abuse. Other causes of CSDH have not been investigated in a large population. PurposeThe purpose of this study was to investigate to what extent external hydrocephalus is present in infants with ASDH and CSDH undergoing evaluation for abuse. Material and methodsEighty-five infants suspected of being abused, with ASDH (n = 16) or CSDH (n = 69), were reviewed regarding age, risk factor profiles, craniocortical width (CCW), sinocortical width (SCW), frontal interhemispheric width (IHW), subarachnoid space width (SSW), and head circumference (HC). In infants with unilateral subdural hematoma (SDH), correlations between contralateral SSW and ipsilateral CCW and SDH width were investigated. ResultsInfants with CSDH had significantly lower mortality, were more often premature and male, and had significantly higher CCW, SCW, IHW, and SSW than infants with ASDH (P < 0.05). Ipsilateral CCW (R = 0.92, P < 0.001) and SDH width (R = 0.81, P < 0.01) correlated with contralateral SSW. Increased HC was more prevalent in infants with CSDH (71%) than in infants with ASDH (14%) (P < 0.01). Forty-two infants, all with CSDH, had at least one of CCW, SCW, or IHW ≥95th percentile. Twenty infants, all with CSDH, had CCW, SCW, and IHW >5 mm, in addition to increased HC. ConclusionA substantial proportion of infants with CSDH who had been suspected of being abused had findings suggesting external hydrocephalus.
Highlights
Subdural haematoma (SDH) is encountered more frequently in infants than in older children [1]
Increased head circumference (HC) was more prevalent in infants with chronic or mixed SDH/hygroma (CSDH) (71%) than in infants with acute subdural haematoma (ASDH) (14%) (p < 0.01)
One limitation of that study was that the International Statistical Classification for Diseases – Tenth Revision (ICD-10) does not differentiate between acute subdural haematoma (ASDH) and chronic or mixed SDH/hygroma (CSDH)
Summary
Subdural haematoma (SDH) is encountered more frequently in infants than in older children [1]. One limitation of that study was that the International Statistical Classification for Diseases – Tenth Revision (ICD-10) does not differentiate between acute subdural haematoma (ASDH) and chronic or mixed SDH/hygroma (CSDH). No study on a large population has investigated the possibility that. The non-traumatic differential diagnoses are to a large degree possible to confirm by thorough medical examination, small vessel malformations can be missed in neuroimaging, and central venous thromboses have a range of aetiologies [13,14]. Journal Pre-proof Material and methods Eighty-five infants suspected of being abused, with ASDH (n=16) or CSDH (n=69), were reviewed regarding age, risk factor profiles, cranio-cortical width (CCW), sino-cortical width (SCW), frontal interhemispheric width (IHW), subarachnoid space width (SSW) and head circumference (HC). In infants with unilateral SDH, correlations between contralateral SSW and ipsilateral CCW and SDH width were investigated
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