Download powerpoint Fig 5. Axial NCCT demonstrates large bilateral subdural collections hyperattenuating to CSF white arrows and a hyperattenuating subdural compartment neomembrane black arrow. On T2WI, the subdural fluid is isointense to CSF white arrows and nicely demonstrates multiple neomembranes black arrows. Four cases demonstrated subdural compartment neomembranes, with very subtle or absent hemosiderin staining along the neomembranes in 2 cases. These observations of subdural fluid signal near or greater than that of CSF and subtle or absent hemosiderin staining may be somewhat counterintuitive because one may reason that chronic subdural hemorrhage should exhibit hypointensity due to susceptibility effects. However, this supposition is not necessarily true and raises several important points. Essential to the formation of a cSDH is the development of vascularized subdural compartment neomembranes. These neomembranes are prone to effusing CSF and microhemorrhages. First, consider the evolution of subdural blood.
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In the other sequences, either variability was large or contrast coefficients stayed constant over time. Caffey’s landmark article of noted an association between healing long-bone fractures and chronic subdural hematomas in infancy, and it was the first to draw attention to physical abuse as a unifying etiology. The consideration of the hematoma shape is expected to further enhance dating using MRI.
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Physicians have an ethical and legal mandate to identify abused children so that they may be protected from further harm and are simultaneously required to think broadly and objectively about differential diagnoses. The medical literature is replete with examples of medical diseases that mimic abuse, potentially leading to misdiagnoses and subsequent harm to children and families. This review highlights some of the common and uncommon diseases that mimic physical and sexual abuse of children.
Christian provides medical-legal expert work in child abuse cases. Published January 25, Accessed January 13, 2. The effects of childhood stress on health across the lifespan. Burden and consequences of child maltreatment in high-income countries. The mistaken diagnosis of child abuse:
February 1, Child abuse is a relatively common problem in our society. S it is estimated that 4 million children a year are abused in some manner. At least two thousand children die as a result of this abuse. This overview focusses on the role of diagnostic imaging in depicting the findings that are specific for child abuse. Awareness of the radiologist is essential in finding these skeletal and CNS injuries in order to document child abuse, to stop further abuse and to protect siblings.
The term shaken infant syndrome probably best describes the classic pattern of injuries.
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The Journalrecognizes that these 2 authorities are diametrically opposed in their opinions, and in the interest of fair academic discourse, we are publishing both the letter to the editor and response to the editor in electronic form for those interested in this highly contentious debate. We leave it to the reader to judge the original article, its critique, and rebuttal, on their own merits.
Given the complex and contentious nature of the subject matter, I am impressed that it took less than 4 weeks for a meaningful peer review to occur, for recommending revisions for the author, and for receiving those revisions. Unfortunately, I fear the piece by Dr Gabaeff does not contribute to a substantive deconstruction of some of the basic tenets of child abuse pediatrics or further the discussion. I would like to point out some of the methodologic flaws the author makes so as to afford your readership a more accurate appreciation of this complex and often contentious field.
Owing to space constraints, I cannot present a counterfactual argument for each of the presented hypotheses. This technique gives the appearance of cited literature support for an unsupported opinion. The first example of this is when the author discusses the work of Dr Ommaya in whiplash forces on the brain and cervical spine of monkeys. Another example of this is when the author describes the hypothesis that shaking an infant is dangerous.
This technique is used to divert attention away from an underlying argument by introducing a tangential and irrelevant argument theme. The forces generated by the collisions of adults playing football are physiologically and biomechanically unrelated to the theory that shaking of an infant can result in retinal hemorrhages. While this is an important article as support for consideration of falls as a cause of death in young children, to imply that it supports that a short household fall can kill an infant is misleading.
Nontraumatic Intracerebral and Subarachnoid Hemorrhage
Facts about the brain: The brain contains around billion neurons. We have all our neurons when we are babies, but they aren’t yet connected as in an adult.
A subdural hematoma (SDH), is a type of hematoma, usually associated with traumatic brain injury. Blood gathers between the inner layer of the dura mater and the arachnoid mater. Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue.
Subarachnoid Hemorrhage Subarachnoid hemorrhage is the result of a blood vessel bursting in the subarachnoid space, which is the area just outside of the brain. This causes the area to quickly fill with blood. Get a Free Legal Evaluation Symptoms of Subarachnoid Hemorrhage As a result of the rapid, intense pressure, the most common symptom of subarachnoid hemorrhage is sudden, severe headache.
This pain is often described afterward as the worst headache ever experienced by the patient. Other symptoms include neck pain, nausea, and vomiting. In some cases, loss of consciousness and death occur. Causes of Subarachnoid Hemorrhage The most frequent cause of subarachnoid hemorrhage is abnormalities in the arteries located at the base of the brain. Called cerebral aneurysms , there are small areas of either rounded or irregular swellings in the arteries.
As the swelling continues the arteries weaken, and become prone to breaking. While subarachnoid hemorrhages can occur in people of any age and any gender, they are slightly more common in women than in men. Prognosis of Subarachnoid Hemorrhage Prognosis is grim, with mortality and permanent disability a common result of subarachnoid hemorrhage. About 35 percent of patients die from the first subarachnoid hemorrhage, while another 15 percent die from a subsequent aneurysm within days or weeks.
Some degree of permanent brain damage is common among survivors. You may be interested In:
Father charged with murder in Kinston baby’s death
The need for expertise in the care of the acute stroke patient is governed by three, well-established goals: To minimize the extent of brain injury. To medically support the stroke patient and encourage optimal chance for functional recovery. To prevent further brain injury secondary to the initial accident or repeated vascular accidents.
The above goals are unlikely to change though the tools available to achieve them are constantly being refined.
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MRI, although often excellent at detecting intracranial injuries, has been shown to be much less sensitive at detecting skull fractures [ 13 ]. Whether from accidental or abusive injuries, our ability to detect subtle fractures, many that might have been difficult to see during the era when only axial CT images could be obtained, has clearly increased with the routine use of sagittal, coronal, and 3-dimensional reconstructions of the skull from CT head exams Fig.
Radiology practices should consider routinely including these multiplanar reconstructions, especially in the pediatric and child abuse populations where they also help delineate normal structures, such as sutures or vascular grooves from a potentially overcalled fracture [ 14 ] Fig. These reconstructions further delineate depressed or complex fractures of the skull and may help to show how a fracture that appears more complex on radiographs may actually represent one impact, as the fracture extent is more easily followed across sutures or over the cranial vertex.
At our institution, if a child has a head CT with multiplanar reconstructions prior to the skeletal survey, we eliminate the skull radiographs from the initial skeletal survey, as we have found that no skull fracture detected on skull radiographs was missed on the head CT images. There is also extension into the left occipital bone arrowhead. The child subsequently underwent an emergent decompressive hemicraniectomy Fig. Subtle, asymmetric soft tissue swelling may lead the radiologist to more carefully evaluate the underlying bones and allow detection of subtle fractures.
Acute fractures usually present with overlying soft tissue swelling, but swelling may be difficult to detect clinically in some patients. It is often helpful to review the bone algorithm images on a more intermediate setting, such as would be used to view an abdomen CT, to look for subtle swelling. In some cases, soft tissue swelling may be difficult to detect initially and may increase over a period of days.
Also, lack of swelling may point to a more remote fracture. Unlike long bone injuries, skull fractures do not demonstrate the typical pattern of healing and periosteal reaction that is used to detect skeletal injuries on follow-up skeletal surveys. Therefore, skull radiographs should not be routinely included on follow-up skeletal surveys looking for fractures that may have been occult on the initial exam [ ].
SBS: SUBDURAL HEMATOMA (OTHER CAUSES)
Online media reported that netizens left critical comments like, “It was such a bad guess that left me shocked,” “The reason is not AKB, but long hours of work! The media reported, “The broadcast did not provide detailed explanation about the matter. The survey conducted to men and women aged 20 to 49 years. The Japanese government has been making efforts to promote marriage and boost the country’s low fertility rate under its goal of raising the total fertility rate to 1.
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I have an anxiety disorder on and off. This raises my BP readings. The risk here is sudden incapacitation. Still is a disqualifier. Does vertigo disqualify me from getting a medical card? When the medical examiner does his examination, one of the things he is looking for is things that would be unsafe for you as a driver and how it effects your ability to maintain control of a commercial motor vehicle. Part of that examination is to test for virtigo. If he feels the condition is unsafe then he will not pass you.
If he feels there is something that can help you maintain, he may make a suggestion for you to follow-up with a specialist. Drivers who have had one unprovoked seizure by definition do not have epilepsy 2 or more unprovoked seizures. Drivers who are seizure-free and off anticonvulsant medication s for at least 5 years after a single unprovoked seizure can be certified.
Acute Subdural Hematoma
Of particular interest historically has been the gross assessment of contusions, which show a stepwise progression of color change as a function of time, implicating catabolism of heme and the elaboration of bile, hemosiderin, and hematoidin, and other pigmented byproducts [ 1 Hughes VK, Ellis PS, Burt T, Langlois NE. The practical application of reflectance spectrophotometry for the demonstration of haemoglobin and its degradation in bruises.
J Clin Pathol ; 57 4: Dating of bruises in children: Pediatrics ; 4: Estimation of the age of bruising.
The cases of the Naval Criminal Investigative Service’s Washington, D.C. Major Case Response Team, led by Special Agent Leroy Jethro Gibbs. Special Agent Leroy Jethro Gibbs is the leader of a team of special agents belonging to the NCIS (Naval Criminal Investigative Service) Major Case Response Team.
Uscinski described an experiment set up by A. Ommaya who “devised an experiment to measure more precisely the amount of rotational acceleration necessary to reach the threshold of injury. A contoured fiberglass chair was built, mounted on wheels, and placed on tracks with a piston behind it. Rhesus monkeys were strapped into the chair with their heads free to rotate.
The piston then impacted the chair, simulating a rear-end motor vehicle collision. Ommaya was able to produce intracranial injury in 19 of the animals, with 11 of them also demonstrating neck injury. At that time it was shown quantitatively that impact was required to generate adequate force. Yet no laboratory proof of this possibility has ever been put forth.
In fact, the available experimental evidence, beginning as far back as , addressed directly in and reproduced in , seems to indicate the contrary. Supposedly, the clearer the symptoms, the more sure the diagnosis of SBS. As detailed below, accidental falls were the only observed cause of these symptoms. The shaken baby syndrome is a form of child abuse in young children.
MRI of the Neonatal Brain
The Amanda Truth Project: Bleeding between the brain and skull subdural hematoma 2. Bleeding behind the eye bilateral retinal hemorrhaging 3. Ayub Ommaya ‘s article “Whiplash.
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Confusion Weakness in limbs on one side of the body If the condition goes undiagnosed and more blood causes additional brain tissue compression, more severe signs and symptoms include: Lethargy Unconsciousness Treatment for Subdural Hematoma Treatment for hematoma often includes surgery, depending on the severtity. Doctors may opt to simply observe the subdural hematoma with repeated head imaging tests. Medications designed to reduce and control swelling in the brain are also used, such as diuretics and corticosteroids.
If the subdural hematoma is severe and life-threatening, emergency surgery may be needed. Doctors may perform a craniotomy, which creates a large opening in the skull to drain blood and relieve pressure on the brain. Alternatively, the doctor may perform a craniectomy in which a section of the skull is removed for an extended period of time to allow the injured brain to expand and swell without permanent damage.
This form of treatment is not often used to treat sudural hematoma. Prognosis for Subdural Hematoma Degree and rate of recovery varies from patient to patient, depending upon the severity of the subdural hematoma, as well as how quickly it was discovered and treated. As a general rule of thumb, adults experience most of their recovery within six months, while children recover more quickly and more completely.
Seizure, which can most often be controlled with medication, is a common long-term complication. You may be interested In: