title: Progression of chronic subdural haematomas in an infant boy after abusive head trauma.
abstract: Abusive head trauma is a serious form of child abuse that can lead to severe neuropsychological sequelae or death in infants. In questionable cases, without a confession from the caregivers and ambiguous clinical information, evidence for the diagnosis of abusive head trauma is often based on typical patterns that have been observed in neuro-imaging. This study shows the progressive evolution of multifocal chronic subdural haematomas, including re-bleedings, in a case of abusive head trauma in an infant boy who was documented with repeated magnetic resonance imaging. The chronic subdural haematomas occurred during closely monitored in-patient rehabilitative care, and repeated maltreatment did not appear to be likely. Due to excessive growth, neurosurgical intervention with endoscopic craniotomy, evacuation of the subdural haematomas and temporal external cerebrospinal fluid drainage was performed with a favourable recovery. This study discusses the current pathophysiological knowledge concerning the development and clinical course of chronic subdural haematomas and draws relevant conclusions for the clinical practice and psychosocial management of caring for victims of abusive head trauma.
authors.affiliation: Department of Pediatrics, University Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. eva.wuerfel@googlemail.com
authors.forename: E
authors.initials: E
authors.lastname: Wuerfel nee Tysiak
authors.forename: Dirk
authors.initials: D
authors.lastname: Petersen
authors.forename: Stefan
authors.initials: S
authors.lastname: Gottschalk
authors.forename: Ivana
authors.initials: I
authors.lastname: Gerling
authors.forename: Jan
authors.initials: J
authors.lastname: Gliemroth
authors.forename: Ute
authors.initials: U
authors.lastname: Thyen
mesh_terms: D001284:Atrophy; D002649:Child Abuse; D006259:Craniocerebral Trauma / Q000150:complications* / Q000473:pathology*; D003399:Craniotomy; D018450:Disease Progression; D006257:Head / Q000473:pathology; D020200:Hematoma, Subdural, Chronic / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012008:Recurrence; D038642:Shaken Baby Syndrome / Q000150:complications* / Q000473:pathology*; D014057:Tomography, X-Ray Computed