Non-accidental injury - bilateral subdural with acute blood

Case contributed by Dr Jeremy Jones

Presentation

Small child presented after "rolling off a bed and onto the floor". The history was not consistent with the age of the child.

Clinical suspicion was of non-accidental injury and a CT scan performed to exclude intracranial injury confirmed bilateral subdural hemorrhage.

The subdural hemorrhage is of mixed density. This does not mean that there is blood of different ages. Hyperdense material in the subdural hemorrhage represents acute blood.

Case Discussion

Clinical suspicion of non-accidental injury. CT scan performed as part of a full skeletal survey and child protection review. CT confirms subdural collections containing mixed density material. The high-density material is acute blood. Blood remains dense for up to 2 weeks when it is generally accepted that the vast majority of blood will have reduced in density to that approaching parenchyma.

Fluid of different densities within the subdural space may occur because of:

  • blood of different ages
  • acute blood mixed with CSF
  • acute blood mixed with fluid in the subdural space

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