Abstract
Some authors have suggested that in the fetus, neonate and infant, intradural hemorrhage (IDH) is relatively common and often presents alongside subdural hemorrhage (SDH). These authors have theorized that pediatric SDH may result from an IDH due to blood leakage from a dural vascular plexus. In this study, we report the inter-observer variation for detection of IDH from a retrospectively collected series of pediatric autopsy photographs, with and without SDH. Autopsy photographs of the falx and tentorium from 27 neonatal, infant and early childhood autopsies were assessed by two independent consultant forensic pathologists blinded to all case histories for the presence and extent (focal or diffuse) of IDH. Inter-observer agreement between the pathologists was calculated using Cohen’s kappa coefficient. The occurrence of subdural hemorrhage was also recorded at autopsy. A kappa coefficient value of 0.669 (p = 0.001), indicated a substantial level of agreement for the presence/absence of IDH between the pathologists. For the extent of IDH a kappa coefficient value of 0.6 (p = 0.038) indicated a moderate level of agreement. The pathologists agreed on the presence of IDH in 10 of the 27 cases. Subdural hemorrhage was recorded for 8 out of 27 cases. Of these 8 cases, it was agreed that 4 had IDH. Using standardized methods of image capture and assessment, inter-observer agreement for the presence/absence of IDH was substantial. In this paper, we report a much lower frequency of macroscopic IDH occurring alongside SDH than previous studies, which included both gross observation of IDH and histological examination.
Highlights
It has been suggested that intradural hemorrhage is relatively common in the perinatal, neonatal, infant, and early childhood age groups, including in alleged cases of abusive head trauma (AHT) [1, 2]
For intradural hemorrhage (IDH) to result in subdural hemorrhage (SDH) that is macroscopically visible at post-mortem, one might expect that the area of bleeding within the dura would need to be extensive enough to diffuse out of the membrane, into the subdural compartment, as proposed
We describe the occurrence of macroscopically visible intra-falcine and intra-tentorial hemorrhages, observed by two consultant forensic pathologists, in a series of photographs from 27 neonatal, infant and early childhood post-mortem examinations
Summary
It has been suggested that intradural hemorrhage is relatively common in the perinatal, neonatal, infant, and early childhood age groups, including in alleged cases of abusive head trauma (AHT) [1, 2]. Over the last two decades, alternative theories have emerged which suggest that infantile subdural bleeding may result from hypoxia, brain swelling and raised central venous pressure [1] and that the source of blood leakage is arterial and venous plexuses within the dura itself [3]. These theories, suggest that an intradural hemorrhage (IDH) occurs, subsequently producing a SDH via leakage out of the dura [4]. For IDH to result in SDH that is macroscopically visible at post-mortem, one might expect that the area of bleeding within the dura would need to be extensive enough to diffuse out of the membrane, into the subdural compartment, as proposed
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
