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The American Journal of Forensic... Dec 2003Several controversies exist regarding ultimately lethal head injuries in small children. Death from short falls, timing of head injury, lucid intervals, presence of... (Review)
Review
Several controversies exist regarding ultimately lethal head injuries in small children. Death from short falls, timing of head injury, lucid intervals, presence of diffuse axonal injury (DAI), and subdural hematoma (SDH) as marker of DAI are the most recent controversial topics of debate in this evolving field of study. In this area of debate, we present a case of delayed death from a witnessed fall backwards off a bed in a 9-month-old black male child who struck his head on a concrete floor and was independently witnessed as "healthy" postfall for 72 hours until he was discovered dead in bed. Grandmother, babysitter, and mother all independently corroborated under police investigation that the child "acted and behaved normally" after the fall until death. Autopsy showed a linear nondisplaced parietal skull fracture, diastasis of adjacent occipital suture, subgaleal hemorrhage with evidence of aging, small posterior clotting SDH, marked cerebral edema, and a small tear of the midsuperior body of the corpus callosum consistent with focal axonal injury (FAI). No DAI was seen, and there were no retinal hemorrhages. All other causes of death were excluded upon thorough police and medical examiner investigation. Although this seems to be a rare phenomenon, a delayed, seemingly symptom-free interval can occur between a clinically apparent mild head injury and accidental death in a young child.
Topics: Accidental Falls; Brain Edema; Corpus Callosum; Death, Sudden; Humans; Infant; Intracranial Hemorrhage, Traumatic; Male; Occipital Bone; Parietal Bone; Skull Fractures; Time Factors
PubMed: 14634479
DOI: 10.1097/01.paf.0000097851.18478.16 -
Singapore Medical Journal Mar 1998While posterior fossa extradural haematomas (PFEDH) may lead to rapid neurological deterioration and death because of brainstem compression, prompt treatment often leads...
OBJECTIVES
While posterior fossa extradural haematomas (PFEDH) may lead to rapid neurological deterioration and death because of brainstem compression, prompt treatment often leads to a good outcome. The non-specific clinical signs and the rarity of this lesion in craniocerebral trauma adds to the difficulty in diagnosis. The aim of this study was to identify features which could lead to an early diagnosis.
METHODS
Seventeen patients with posterior fossa extradural haematomas were operated on over 4 1/2 years, accounting for 7.5% of the 226 surgically operated extradural haematomas in the Department of Neurosurgery, Tan Tock Seng Hospital, Singapore. Four patients were excluded from this study due to non-availability of the case records. The remaining 13 patients formed the study group in this retrospective analysis.
RESULTS
The majority of cases (77%) presented acutely within 24 hours. The mechanism of injury varied from a fall in 7 cases, a road traffic accident in 4 cases and assault in 2. Nine patients had evidence of external injury to the occiput, 8 patients had skull fractures, and diastasis of the lambdoid suture was seen in 2 cases. Presence of aerocele was noted in the CT scan of 4 cases. All 9 cases admitted with a high GCS score of more than 8 had a very good outcome.
CONCLUSION
An early CT scan head is recommended if a combination of the following features is present: occipital soft tissue injury, drowsiness, occipital fracture or diastasis of the lambdoid suture.
Topics: Accidental Falls; Accidents, Traffic; Adolescent; Adult; Air; Brain Stem; Child; Child, Preschool; Cranial Fossa, Posterior; Cranial Sutures; Female; Glasgow Coma Scale; Hematoma, Epidural, Cranial; Humans; Male; Occipital Bone; Parietal Bone; Retrospective Studies; Skull Fractures; Sleep Stages; Tomography, X-Ray Computed; Treatment Outcome; Violence
PubMed: 9632968
DOI: No ID Found -
British Journal of Neurosurgery 1989Twenty patients with an epidural haematoma of the posterior fossa (EPIPF) among a total number of 359 patients with an epidural haematoma are reported (5.6%). Nine... (Review)
Review
Twenty patients with an epidural haematoma of the posterior fossa (EPIPF) among a total number of 359 patients with an epidural haematoma are reported (5.6%). Nine patients obtained a good outcome, four patients had a moderate disability and seven patients died (mortality 35%). Mortality of the acute cases was 50%, of the subacute cases 20%. In general, the clinical features were uncertain. Sixteen cases showed an occipital skull fracture or diastasis of the lambdoid suture respectively. A total number of 127 cases with EPIPF from the literature since 1961 was studied. The mortality in the CT-diagnosed group ran to 21.7% and to 25.9% in the group without CT. None of the patients showing a subacute course died when the diagnosis was made by CT, in the group without CT, however, four patients out of 11 subacute cases died. Head injured patients with an occipital trauma should therefore undergo CT scanning to detect a surgically significant lesion before clinical deterioration occurs.
Topics: Adolescent; Adult; Brain Injuries; Child; Child, Preschool; Female; Hematoma, Epidural, Cranial; Humans; Infant; Male; Middle Aged; Radiography
PubMed: 2679686
DOI: 10.3109/02688698909002792 -
No Shinkei Geka. Neurological Surgery Jun 1978The authors presented a case of a subacute epidural hematoma of the posterior fossa, for which we never thought of a head injury at the admission. We discussed the...
The authors presented a case of a subacute epidural hematoma of the posterior fossa, for which we never thought of a head injury at the admission. We discussed the diagnosis (the clinical pictures and X-ray findings), stressing that CT plays an important role especially in diagnosing posterior fossa diseases. Our case could probably not be diagnosed correctly without CT, because the conventional X-ray examinations did not reveal clearly the space--occupying lesion in the posterior fossa, before CT was done. The following findings can be a clue to diagnose a posterior fossa hematoma: 1. occipital fracture (which was not found in our case) or suture diastasis, occipital scalp contusion, 2. progessive conscious disturbance, cerebellar and brain stem signs, pyramidal sigs and neck stiffness, 3. a patient has a tendency to lie on the side, especially on the lesion side. On angiography, substraction films must be obtained especially for the posterior fossa diseases. The posterior fossa veins of our case were opacified less on the left than on the right, and the left transverse sinus was apparently amputated in its opacification. These findings were due directly to the compression of the epidural hematoma. CT can promptly not only a posterior fossa hematoma, but also accompanied supratentorial lesions (concrecoup injury etc) simultaneously, therefore one can expect that there are not errors any more with CT to overlook the supratentorial contrecoup injury. Posterior fossa hematomas have usually a venous bleeding origin, from the transverse sinus, torcular Herophilli, emissary veins, bridging vein etc. therefore, present a slowly progressive and intermittent neurological signs, as the hematomas grow slowly.
Topics: Adult; Cranial Fossa, Posterior; Hematoma, Epidural, Cranial; Humans; Male; Radiography
PubMed: 673130
DOI: No ID Found -
The Medical Journal of Australia Aug 1977A case of traumatic basal subarachnoid haemorrhage and fractured mandible following a blow to the neck is described. The characteristic findings exhibited were diastasis...
A case of traumatic basal subarachnoid haemorrhage and fractured mandible following a blow to the neck is described. The characteristic findings exhibited were diastasis of the atlanto-occipital joint with subluxation of the right side of the first cervical vertebra, in the absence of a demonstrable abnormality of the cerebral circulation.
Topics: Adult; Female; Forensic Medicine; Humans; Mandibular Fractures; Neck Injuries; Subarachnoid Hemorrhage; Wounds, Nonpenetrating
PubMed: 909485
DOI: 10.5694/j.1326-5377.1977.tb99141.x