CT – previous craniotomy, burr hole, subdural hematomas bilateral L > R, dual attenuation of subdurals, hematoma under scalp left parietal region. Acute bleed and cranial swelling hyperdense but equal in density
MR SCAN- acute on chronic subdural collection with more recent bleed, bilateral extending into the posterior inter-hemispheric fissures.
MR SCAN- acute on chronic subdural collection with more recent bleed, bilateral extending into the posterior inter-hemispheric fissures.
Dating of subdural collections about 3 weeks before scan, intensity of acute subdural collection and scalp hematoma – same
Increased intensity ? Due to sedimentation ? Acute bleed.
Left temporal and parietal atrophy compared to right
Dad unaware of fall
Dad unaware of fall
Previous history in Pakistan about 3 months ago.
D & V- pale, low Hb, fits followed by Rt sided weakness. Glasgow coma scale -4/15
CT- left large extradural hematoma with no fracture- evacuation- improvement
History of fall??. Skeletal survey normal.
First cousins, close family ties.
Findings normal apart from left parietal swelling. Normal neurology. No other bruises.
Americal Journal of Paediatrics: Fatal abusive head injuries in infants and children: rebleeding spontaneous should not be offered as explanation in absence of previous injury and re injury which may be trivial.
Americal Journal of Paediatrics: Fatal abusive head injuries in infants and children: rebleeding spontaneous should not be offered as explanation in absence of previous injury and re injury which may be trivial.
Paediatric chronic subdural hematoma: a retrospective analysis; Paediatric Neurosurgery 1992
Waxing and waning during course and so re bleeding with trivial trauma/impact.
Trial of Randall Alexander -Georgia v Brady: during organisation of subdurals- blood vessels which are forming are still fragile and with minor bump one can get a fresh bleeding. Re bleeds are venous and gradual so often there may not be symptoms.
“Sometimes identification of a chronic and acute SDH makes the well-paid ‘prosecution experts’ jump to the conclusion that his finding must mean recurrent abuse when in fact the opposite conclusion may be more appropriate. The simple fact that the baby was well-cared for and had no visible external injuries when seen repeatedly for routing paediatric care , while having a subdural haemorrhage, is strong evidence against inflicted trauma”- Shaken or not: that is the question- Edward Yazbak
“Sometimes identification of a chronic and acute SDH makes the well-paid ‘prosecution experts’ jump to the conclusion that his finding must mean recurrent abuse when in fact the opposite conclusion may be more appropriate. The simple fact that the baby was well-cared for and had no visible external injuries when seen repeatedly for routing paediatric care , while having a subdural haemorrhage, is strong evidence against inflicted trauma”- Shaken or not: that is the question- Edward Yazbak