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Pediatric Radiology May 2021A growing body of evidence links abusive head trauma (AHT) to patterns of direct and indirect spinal injuries, such as spinal subdural hemorrhage (SDH). Identification... (Review)
Review
A growing body of evidence links abusive head trauma (AHT) to patterns of direct and indirect spinal injuries, such as spinal subdural hemorrhage (SDH). Identification of evidence of spinal injury such as spinal SDH plays a crucial role in the diagnosis and subsequent management of the index child with AHT and his or her siblings. In a value-based practice of medicine, it can be argued that adding spine imaging to identify spinal SDH in the workup of AHT adds value to both the short- and long-term management of the patient. This pictorial review describes the normal appearance of spinal SDH and challenges of identifying spinal SDH, and it explores the mechanism of spinal SDH development in AHT.
Topics: Child; Child Abuse; Craniocerebral Trauma; Female; Hematoma, Subdural; Humans; Infant; Magnetic Resonance Imaging; Male; Retrospective Studies
PubMed: 33999240
DOI: 10.1007/s00247-020-04931-7 -
Emergency Radiology Oct 2019Acute subdural hemorrhage (SDH) is commonly encountered by emergency radiologists in the setting of trauma. When history or imaging evidence of trauma is absent, the... (Review)
Review
Acute subdural hemorrhage (SDH) is commonly encountered by emergency radiologists in the setting of trauma. When history or imaging evidence of trauma is absent, the differential diagnosis for SDH should be expanded. Intracranial aneurysm rupture is a rare and underrecognized cause of SDH which may present without concurrent subarachnoid hemorrhage. The mechanism of aneurysmal SDH is controversial, but understanding the anatomic microenvironment of the aneurysm provides insight and clarifies aneurysm features predisposing to subdural compartment rupture. Aneurysmal SDH is a neurosurgical emergency and its treatment strategies differ from traumatic SDH. Outcomes are poor if treatment is delayed; thus, radiologists play a central role in recognizing this uncommon but potentially devastating complication of aneurysm rupture. The goal of this article is to familiarize radiologists with clinical and imaging characteristics of aneurysmal SDH and review pertinent anatomy, risk factors, and potential etiologies. Aneurysmal rupture can easily be overlooked in the routine workup of atraumatic SDH, and radiologists must know when to recommend vascular imaging to avoid the catastrophic consequences of a missed diagnosis.
Topics: Aneurysm, Ruptured; Diagnosis, Differential; Hematoma, Subdural, Acute; Humans; Intracranial Aneurysm; Risk Factors
PubMed: 31037589
DOI: 10.1007/s10140-019-01691-2 -
Neurosurgery Clinics of North America Apr 2017Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary,... (Review)
Review
Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence.
Topics: Blood Pressure; Brain Injuries; Cerebrovascular Circulation; Critical Care; Hematoma, Subdural, Acute; Humans; Intracranial Pressure; Postoperative Care; Resuscitation; Seizures; Stomach Ulcer; Tomography, X-Ray Computed; Venous Thrombosis
PubMed: 28325461
DOI: 10.1016/j.nec.2016.11.009 -
Critical Care Medicine Dec 2023
Topics: Humans; Seizures; Hematoma, Subdural, Acute
PubMed: 37971343
DOI: 10.1097/CCM.0000000000006047 -
Journal of Clinical Neuroscience :... Jul 2021Subdural hemorrhage (SDH), the accumulation of blood between the dura and arachnoid mater, is one of the most commonly encountered traumatic findings in emergency... (Review)
Review
Subdural hemorrhage (SDH), the accumulation of blood between the dura and arachnoid mater, is one of the most commonly encountered traumatic findings in emergency radiology setting. The purpose of this essay is to review the pitfalls in the diagnosis of SDH including a) mimics on CT imaging and b) etiology other than accidental trauma. We describe several entities that closely mimic SDH on non-contrast CT scans. A knowledge of these mimics is essential in the emergency setting since overdiagnosis of SDH can lead to unnecessary hospital admissions, potentially invasive procedures, or even delay in necessary treatment. The mimics of SDH on non-contrast head CT include: PATHOLOGIC ENTITIES IATROGENIC MIMICS ANATOMIC/PHYSIOLOGIC MIMICS ARTIFACTUAL MIMICSWe also briefly review non-accidental and non-traumatic causes of SDH. Although, the most common cause of SDH is accidental trauma, other routinely encountered causes of SDH include coagulopathy, non-accidental trauma, cranial surgery, vascular malformations etc. CONCLUSION: Clinicians dealing with SDH in the emergency setting should consider SDH mimics and less common etiologies of SDH in order to facilitate appropriate patient management.
Topics: Diagnosis, Differential; Hematoma, Subdural; Humans; Tomography, X-Ray Computed
PubMed: 34119298
DOI: 10.1016/j.jocn.2021.02.006 -
Developmental Medicine and Child... Dec 2000
Review
Topics: Adult; Epilepsy; Female; Fetal Diseases; Hematoma, Subdural; Humans; Hydrocephalus; Infant, Newborn; Language Development Disorders; Male; Pregnancy; Prenatal Diagnosis; Ultrasonography, Prenatal
PubMed: 11132259
DOI: 10.1017/s0012162200001559 -
Pediatric Radiology May 2021Enlarged subarachnoid spaces are a common finding in infants and young children imaged for macrocephaly or an enlarging head circumference, and benign enlargement of the... (Review)
Review
Enlarged subarachnoid spaces are a common finding in infants and young children imaged for macrocephaly or an enlarging head circumference, and benign enlargement of the subarachnoid spaces is often diagnosed. Infrequently, presumed "spontaneous" subdural hemorrhages or subdural collections might complicate these enlarged subarachnoid spaces. Children with large bilateral subdural collections might also present for imaging with macrocephaly. Each scenario potentially raises concerns for prior injury because subdural hemorrhage is a frequent finding in children with abusive head trauma.
Topics: Child; Child Abuse; Child, Preschool; Craniocerebral Trauma; Hematoma, Subdural; Humans; Infant; Megalencephaly; Subarachnoid Space
PubMed: 33999235
DOI: 10.1007/s00247-020-04848-1 -
JAMA Jul 1960
Topics: Cerebral Hemorrhage; Hematoma, Subdural; Humans
PubMed: 13794235
DOI: 10.1001/jama.1960.73020300005019c -
Pediatric Radiology May 2021Birth trauma accounts for 1-2% of the mortality in newborns with significant intracranial injuries presenting in the immediate postnatal period. However, a significant... (Observational Study)
Observational Study
BACKGROUND
Birth trauma accounts for 1-2% of the mortality in newborns with significant intracranial injuries presenting in the immediate postnatal period. However, a significant number of asymptomatic neonates harbor birth-related intracranial hemorrhage (ICH), with birth-related subdural hemorrhage (SDH) being a common occurrence on infant brain CT and MRI studies performed as a standard of care for a variety of reasons. Although clinically insignificant, birth-related SDH is frequently brought up in courts as an alternative explanation for SDH in suspected abusive head trauma.
OBJECTIVE
The aim of this study was to determine prevalence, imaging morphology and distribution of birth-related SDHs on brain CT and MRI studies obtained as a standard of care in infants up to 1 month old. We further tried to ascertain the relationship of birth-related SDHs with mode of delivery and birth weight.
MATERIALS AND METHODS
Infants up to the age of 1 month who had CT or MRI of the brain performed between Jan. 1, 2018, and March 29, 2020, were included in this retrospective observational study. In addition to the imaging data, we reviewed clinical history, birth history including birth weight and mode of delivery, and final diagnoses.
RESULTS
Two hundred six infants younger than 30 days (range 0-29 days, mean 11.9 days, median 11 days and standard deviation [SD] 8.4 days) had a CT or MRI study during the study period. Among these, 58 infants were excluded as per the exclusion criteria. Among the included 148 infants, 88 (59.5%) had no imaging evidence of SDH. An additional 56 (37.8%) infants were assessed as having birth-related SDH based on review of clinical data. Within the birth-related SDH cohort (56 infants), only supratentorial SDH was identified in 5 (8.9%), only infratentorial SDH was identified in 14 (25%), while SDHs within both compartments were identified in 37 (66.1%) infants. The most common location for supratentorial birth-related SDH was along the occipital lobes (31/42, 73.8%), with other common locations being along the posterior interhemispheric fissure (30/42, 71.4%) and fronto-parietal convexity (9/42, 21.4%). The distribution of posterior fossa SDH was along the tentorium (38/51, 74.5%), along the cerebellum (38/51, 74.5%) and in both the locations (25/51, 49.0%). The rate of SDH was significantly higher in vaginal delivery group (46/84, 54.7%) as compared to caesarean section group (10/57, 17.5%) (P<0.05). We did not find any statistically significant difference between the birth weights of normal and birth-related SDH cohorts (P>0.05).
CONCLUSION
Birth-related SDH is a common occurrence, with our study suggesting a prevalence of 37.8%. The most common distribution of birth-related SDH is within both the supra- and infratentorial compartments (66.1%) followed by infratentorial compartment (25%). The rate of birth-related SDH was significantly higher in vaginal delivery group as compared to caesarean section group.
Topics: Cesarean Section; Hematoma, Subdural; Humans; Infant, Newborn; Magnetic Resonance Imaging; Neuroimaging; Observational Studies as Topic; Prevalence; Retrospective Studies
PubMed: 33830289
DOI: 10.1007/s00247-021-05060-5 -
Journal of Clinical Rheumatology :... Dec 2021
Topics: Hematoma, Subdural; Hemorrhage; Humans; Scleroderma, Systemic
PubMed: 33252398
DOI: 10.1097/RHU.0000000000001649