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External Hydrocephalus as a Cause of Infant Subdural Hematoma: Epidemiological and Radiological Investigations of

Jacob Andersson1, Johan Wikström2, Ulf Högberg3

  • 1Forensic Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Pediatric Neurology
|November 4, 2021
PubMed

Insights

Chronic subdural hematoma (CSDH) in infants suspected of abuse may indicate external hydrocephalus. This study found that a significant number of infants with CSDH showed signs of this condition, suggesting it as a potential alternative cause.

Area of Science:

  • Pediatric Neurology
  • Neuroradiology
  • Forensic Pediatrics

Background:

  • Acute subdural hematoma (ASDH) and chronic subdural hematoma (CSDH) in infants are often considered indicators of abuse.
  • However, alternative causes for CSDH, particularly in large populations, remain under-investigated.

Purpose of the Study:

  • To investigate the prevalence of external hydrocephalus in infants diagnosed with ASDH or CSDH who are undergoing evaluation for suspected abuse.
  • To explore potential non-abuse related etiologies for subdural hematomas in infants.

Main Methods:

  • A retrospective review of 85 infants suspected of abuse with ASDH (n=16) or CSDH (n=69).
  • Analysis included age, risk factors, craniocortical width (CCW), sinocortical width (SCW), interhemispheric width (IHW), subarachnoid space width (SSW), and head circumference (HC).
  • Correlations between contralateral SSW and ipsilateral CCW/SDH width were examined in unilateral SDH cases.

Main Results:

  • Infants with CSDH exhibited significantly higher CCW, SCW, IHW, and SSW compared to those with ASDH.
  • Increased head circumference was more prevalent in CSDH infants (71%) than ASDH infants (14%).
  • Forty-two CSDH infants had at least one measurement (CCW, SCW, IHW) at or above the 95th percentile, with twenty showing increased HC and all three width measurements exceeding 5 mm.

Conclusions:

  • A significant proportion of infants with CSDH, initially suspected of abuse, presented with findings suggestive of external hydrocephalus.
  • These findings highlight the importance of considering external hydrocephalus as a differential diagnosis in infants with CSDH, even when abuse is suspected.
Abstract

Keywords:
Abusive head traumaExternal hydrocephalusHygromaShaken baby syndromeSubdural hematoma

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