Natural history of traumatic meningeal bleeding in infants: semiquantitative analysis of serial CT scans in corroborated cases.
BACKGROUND
The natural history of posttraumatic meningeal bleeding in infants is poorly documented, and the differences between inflicted head injury (IHI) and accidental trauma (AT) are debated. Autopsy findings have suggested that anoxia also plays a role in bleeding; however, these findings may not reflect what occurs in live trauma patients.


OBJECTIVE
We studied the natural history of traumatic meningeal bleeding in infants using serial computed tomography (CT) scans in corroborated IHI and AT.


METHODS
From our prospective series, we selected corroborated cases (confessed IHI or AT having occurred in public), who underwent at least three CT scans in the acute phase. We performed a semiquantitative analysis of meningeal bleeding using a four-tier scale (absent, faint, frank, and thick) derived from the Fisher grading for aneurysmal bleeding in four regions of interest (convexity, falx cerebri, sagittal sinus, and tentorium cerebelli).


RESULTS
We studied 20 cases: ten IHI and ten AT. Bleeding was maximal at the convexity initially, then increased along the falx and sagittal sinus, and then along the tentorium. Decrease and disappearance of blood was variable according to the site and the initial quantity of blood. We found no difference between IHI and AT.


CONCLUSIONS
Our findings suggest that the primary site of meningeal bleeding in infantile head trauma is the convexity of the brain; blood cells then migrate toward the midline following the flow of cerebrospinal fluid circulation and inferiorly following gravity. The pattern of bleeding in traumatic cases appears similar in IHI and AT but different from anoxic lesions.
Vinchon
Matthieu
M
Department of Pediatric Neurosurgery, Lille University Hospital, 59 037, Lille Cedex, France. m-vinchon@chru-lille.fr
Desurmont
Marie
M
Soto-Ares
Gustavo
G
De Foort-Dhellemmes
Sabine
S
D001921:Brain / Q000000981:diagnostic imaging; D002649:Child Abuse; D005260:Female; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D008578:Meninges / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed