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Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Inflicted traumatic brain injury in infants and young children
1Department of Pathology, Division of Forensic Pathology, St. Louis University School of Medicine, St. Louis, MO 63104, USA. mcase@stlouisco.com
Insights
Distinguishing inflicted head injury from accidental injury in children is challenging. Pathological findings and circumstances are key, with subdural hemorrhage being a common indicator of abusive head trauma.
Area of Science:
- Pediatric Traumatology
- Neurotrauma
- Forensic Pathology
Background:
- Inflicted or abusive head injury is a common and significant concern in infants and young children.
- Differentiating between inflicted neurotrauma and accidental injury presents a frequent diagnostic challenge.
- Such injuries often occur in unsupervised domestic settings, complicating witness accounts.
Purpose of the Study:
- To explore the complexities of distinguishing inflicted head injuries from accidental ones in pediatric populations.
- To examine the role of pathological findings and surrounding circumstances in diagnosis.
- To detail the anatomical and biomechanical factors contributing to subdural hemorrhage in abusive head trauma.
Main Methods:
- Review of pathological findings associated with inflicted head injury.
- Analysis of the circumstances surrounding head injuries in infants and young children.
- Consideration of the natural history and anatomical basis of subdural bleeding.
Main Results:
- Subdural hemorrhage is the most frequent pathological finding in inflicted head injuries.
- The distribution and appearance of subdural hemorrhage can vary.
- Understanding the anatomy of the dura and arachnoid is crucial for interpreting bleeding patterns.
Conclusions:
- Distinguishing inflicted from accidental head injury relies on integrating pathological evidence with situational context.
- The specific biomechanical forces involved influence the pattern of subdural bleeding.
- Detailed anatomical knowledge aids in the interpretation of subdural hemorrhage in suspected abusive head trauma cases.
Abstract:
This article will discuss the subject of inflicted or abusive head injury in infants and young children. Inflicted neurotrauma is a very common injury and a frequent problem in attempting to distinguish between inflicted and accidental injury. Inflicted head injury occurs usually in the home in the presence of the individual who has inflicted the injury outside the view of unbiased witnesses. Distinguishing between inflicted and accidental injury may be dependent upon the pathological findings and consideration of the circumstances surrounding the injury. The most common finding in an inflicted head injury is the presence of subdural hemorrhage. Subdural hemorrhage may occur in a variety of distributions and appearances. The natural history of subdural bleeding and the anatomy of the "subdural" will be considered. The anatomy of the dura and its attachment to the skull and to the arachnoid determines how subdural bleeding evolves into the cleaved dural border cell layer and as well as how bridging veins are torn and anatomically where bleeding will occur. Different biomechanical mechanisms result in different distributions of subdural blood and these differences will be discussed.
