Non-accidental injury - skull fracture, subarachnoid hemorrhage and subdural hematoma

Case contributed by Dr Jeremy Jones

Presentation

Emergency admission flat. Glucose normal. Venous gas normal. Boggy swelling right side of the head. No history of head trauma.

Patient Data

Age: 3 months
Gender: Female

Large right extra-cranial hematoma with acute blood within.

Multifocal acute extra-axial hemorrhage, predominantly right convexity on the left.

The extra-axial hemorrhage is confirmed as subarachnoid. In addition, there are bilateral subdural collections. The bilateral subdurals are iso-intense to CSF on the CT. The subdural collections are isointense to CSF on T1 and T2 and hyperintense to CSF on FLAIR (showing incomplete suppression).

Case Discussion

Appearances here are of abusive head trauma. There is no history of head injury. Further assessment confirms no coagulopathy or underlying processes that would predispose bleeding.

Abusive head trauma is a collective term that describes impact head trauma, shaking, or impact head trauma and shaking.

There is evidence of impact head trauma (the skull fracture and extra-cranial hematoma). Acute blood in the extra-cranial and subarachnoid space suggests that this has occurred within the preceding 2 weeks. 

The main question, in this case, is whether this could all occur from a single impact head trauma?

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Case information

rID: 69760
Published: 20th Jul 2019
Last edited: 10th Sep 2019
Tag: nai
Inclusion in quiz mode: Included
Institution: NHS Lothian

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