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Bilateral subdural hematomas from nonaccidental trauma

Case contributed by Abtin Jafroodifar
Diagnosis certain

Presentation

Seizure and facial bruising.

Patient Data

Age: 6 months
Gender: Male

Non-contrast CT of the brain demonstrates scattered areas of hyperdensity in the high bilateral cerebral convexities, consistent with subdural hematomas. There are no calvarial fractures.

MR imaging of the brain demonstrates thin serpenginous vessels on T2 axial and coronal images overlying the cerebral convexities with additional areas of susceptibility on SW images, consistent with venous injuries and subdural blood products. The imaging was confirmatory for subdural hematomas bilaterally.

Color fundus photographs were obtained after pharmacologic dilation of the pupils using phenylephrine, tropicamide, and cyclopentolate. The images demonstrated multiple intraocular hemorrhages of various depths, including intra- and pre-retinal hemorrhages involving more than 50% of the retina. These findings are supportive of, but not pathognomonic for, abusive head trauma.

Case Discussion

This is a case of bilateral Subdural hematomas from confirmed Non-accidental injuries (NAI).

The patient presented with seizures and facial bruising and was found to having thin bilateral subdural hematomas and injured cerebral veins on MR imaging. Child protective services were notified and the patient received appropriate care.

COAUTHOR: Ryan Thibodeau, MD

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