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Related Experiment Videos

Paroxysmal coughing, subdural and retinal bleeding: a computer modelling approach.

J F Geddes1, D G Talbert

  • 1jfgeddes@doctors.org.uk

Neuropathology and Applied Neurobiology
|November 7, 2006
PubMed
Summary

Severe coughing fits, not just shaking, may cause infant subdural and retinal bleeding. Computer modeling shows paroxysmal coughing can dangerously increase infant intracranial pressure, leading to these hemorrhages.

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Area of Science:

  • Pediatrics
  • Neurology
  • Ophthalmology

Background:

  • Infant subdural and retinal hemorrhages are often attributed to abusive head trauma (shaken baby syndrome).
  • Alternative mechanisms involving increased intrathoracic pressure, such as Valsalva maneuvers and pertussis, can cause similar bleeding.
  • Severe paroxysmal coughing is a potential, underrecognized cause of these injuries.

Purpose of the Study:

  • To investigate the potential of feeding accidents, specifically coughing, as a trigger for infant subdural and retinal bleeding.
  • To model the physiological effects of coughing on infant intracranial pressure and venous return.

Main Methods:

  • A dynamic computer model simulating a 3-month-old infant's circulatory system was used.
  • The model was subjected to induced 'coughing' to monitor physiological responses.

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  • Intracranial pressure dynamics and venous return impedance during coughing were analyzed.

    • Main Results:

    • Coughing causes a rapid, exponential increase in intracranial pressure.
    • Individual coughs do not allow pressure to reach dangerous levels due to quick pressure normalization.
    • Sustained, paroxysmal coughing impedes venous return, leading to dangerously high luminal pressures capable of causing vessel damage.

    Conclusions:

    • Paroxysmal coughing can generate sufficient intracranial pressure to cause subdural and retinal hemorrhages in infants.
    • This mechanism offers a plausible explanation for bleeding in some infants with a history of coughing, vomiting, or choking.
    • The findings challenge the sole attribution of these hemorrhages to inflicted injury.