Is external hydrocephalus a possible differential diagnosis when child abuse is suspected?

Acta Neurochirurgica - Tập 164 - Trang 1161-1172 - 2021
Joseph Scheller1, Knut Wester2
1Neurologist in Private Practice, Baltimore, USA
2Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway

Tóm tắt

Criteria for diagnosing abusive head trauma (AHT) or “shaken baby syndrome” are not well defined; consequently, these conditions might be diagnosed on failing premises. The authors have collected a total of 28 infants, from the US (20) and Norway (8), suspected of having been violently shaken, and their caregivers had been suspected, investigated, prosecuted or convicted of having performed this action. Among 26 symptomatic infants, there were 18 boys (69%) and 8 girls (31%)—mean age 5.1 month, without age difference between genders. Twenty-one of 26 symptomatic children (81%) had a head circumference at or above the 90 percentile, and 18 had a head circumference at or above the 97 percentile. After macrocephaly, seizure was the most frequent initial symptom in 13 (50%) of the symptomatic infants. Seventeen (65%) of the symptomatic infants had bilateral retinal haemorrhages, and two had unilateral retinal haemorrhages. All infants had neuroimaging compatible with chronic subdural haematomas/hygromas as well as radiological characteristics compatible with benign external hydrocephalus (BEH). BEH with subdural haematomas/hygromas in infants may sometimes be misdiagnosed as abusive head trauma. Based on the authors’ experience and findings of the study, the following measures are suggested to avoid this diagnostic pitfall: medical experts in infant abuse cases should be trained in recognising clinical and radiological BEH features, clinicians with neuro-paediatric experience should always be included in the expert teams and reliable information about the head circumference development from birth should always be available.

Tài liệu tham khảo

Adamsbaum C, Grabar S, Mejean N, Rey-Salmon C (2010) Abusive head trauma: judicial admissions highlight violent and repetitive shaking. Pediatrics 126:546–555. https://doi.org/10.1542/peds.2009-3647 Alvarez LA, Maytal J, Shinnar S (1986) Idiopathic external hydrocephalus: natural history and relationship to benign familial macrocephaly. Pediatrics 77:901–907 Amodio J, Spektor V, Pramanik B, Rivera R, Pinkney L, Fefferman N (2005) Spontaneous development of bilateral subdural hematomas in an infant with benign infantile hydrocephalus: color Doppler assessment of vessels traversing extra-axial spaces. Pediatr Radiol 35:1113–1117. https://doi.org/10.1007/s00247-005-1503-x Azais M, Echenne B (1992) Idiopathic subarachnoid space enlargement (benign external hydrocephalus) in infants. Ann De Pediatrie 39:550–558 Barnes PD, Galaznik J, Gardner H, Shuman M (2010) Infant acute life-threatening event-dysphagic choking versus nonaccidental injury. Semin Pediatr Neurol 17:7–11. https://doi.org/10.1016/j.spen.2010.01.005 Binenbaum G, Forbes BJ (2014) The eye in child abuse: key points on retinal hemorrhages and abusive head trauma. Pediatr Radiol 44(Suppl 4):S571–S577. https://doi.org/10.1007/s00247-014-3107-9 Binenbaum G, Mirza-George N, Christian CW, Forbes BJ (2009) Odds of abuse associated with retinal hemorrhages in children suspected of child abuse. J Aapos 13:268–272. https://doi.org/10.1016/j.jaapos.2009.03.005 Binenbaum G, Rogers DL, Forbes BJ, Levin AV, Clark SA, Christian CW, Liu GT, Avery R (2013) Patterns of retinal hemorrhage associated with increased intracranial pressure in children. Pediatrics 132:e430–e434. https://doi.org/10.1542/peds.2013-0262 Caffey J (1972) Theory and practice of shaking infants - its potential residual effects of permanent brain-damage and mental-retardation. Am J Dis Child 124:161 Caffey J (1974) Whiplash shaken infant syndrome - manual shaking by extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain-damage and mental-retardation. Pediatrics 54:396–403 Choudhary AK, Narang SK, Moreno JA, Christian CW, Servaes S, Palusci VJ, Hedlund GL, Dias MS, Nelson MD, Silvera VM, Palasis S, Raissaki M, Rossi A, Offiah AC (2018) A consensus response on the complete picture: reply to LynOe and Eriksson (vol 49, pg 424, 2019). Pediatr Radiol 49:692–693. https://doi.org/10.1007/s00247-019-04380-x De Terson A (1900) L’ hemorrhagie dans le corps vitre au cours de l’hemorrhagie cerebrale. Clin Ophthalmol 6:309–312 Donohoe M (2003) Evidence-based medicine and shaken baby syndrome: part I: literature review, 1966-1998. Am J Forensic Med Pathol 24:239–242. https://doi.org/10.1097/01.paf.0000083635.85457.97 Duhaime AC, Alario AJ, Lewander WJ, Schut L, Sutton LN, Seidl TS, Nudelman S, Budenz D, Hertle R, Tsiaras W, Loporchio S (1992) Head-injury in very young-children - mechanisms, injury types, and ophthalmologic findings in 100 hospitalized-patients younger than 2 years of age. Pediatrics 90:179–185 Elinder G, Eriksson A, Hallberg B, Lynoe N, Sundgren PM, Rosen M, Engstrom I, Erlandsson BE, Collaboration E (2018) Traumatic shaking: the role of the triad in medical investigations of suspected traumatic shaking. Acta Paediatr 107:3–23. https://doi.org/10.1111/apa.14473 Feld K, Feld D, Karger B, Helmus J, Schwimmer-Okike N, Pfeiffer H, Banaschak S, Wittschieber D (2020) Abusive head trauma in court: a multi-center study on criminal proceedings in Germany. Int J Legal Med. https://doi.org/10.1007/s00414-020-02435-5 Fessell DP, Frankel DA, Wolfson WP (2000) Sonography of extraaxial fluid in neurologically normal infants with head circumference greater than or equal to the 95th percentile for age. J Ultrasound Med 19:443–447 Fledelius HC (2005) Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse. Acta Ophthalmol Scand 83:424–427. https://doi.org/10.1111/J.1600-0420.2005.00471.X Friede RL, Schachenmayr W (1978) Origin of subdural neomembranes .2. Fine-structure of neomembranes. Am J Pathol 92:69–84 Fukuyama Y, Miyao M, Ishizu T, Maruyama H (1979) Developmental-changes in normal cranial measurements by computed-tomography. Dev Med Child Neurol 21:425–432 Ghosh PS, Ghosh D (2011) Subdural hematoma in infants without accidental or nonaccidental injury: benign external hydrocephalus, a risk factor. Clin Pediatr 50:897–903. https://doi.org/10.1177/0009922811406435 Golden N, Maliawan S (2005) Clinical analysis of non-accidental head injury in infants. J Clin Neurosci 12:235–239. https://doi.org/10.1016/j.jocn.2004.11.001 Gout A, Gautier I, Bellaiche M, Pinard JM, Tremon M, Rodriguez D, Foucaud P (1997) Idiopathic subarachnoid space enlargement in infancy: simple anatomic variant or hemorrhagic risk factor? Arch De Pediatrie 4:983–987. https://doi.org/10.1016/S0929-693x(97)86096-4 Gudjonsson G (2017) Memory distrust syndrome, confabulation and false confession. Cortex 87:156–165. https://doi.org/10.1016/j.cortex.2016.06.013 Guthkelch AN (1971) Infantile subdural haematoma and its relationship to whiplash injuries. Bmj-Brit Med J 2:430 Hellbusch LC (2007) Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-up. J Neurosurg 107:119–125. https://doi.org/10.3171/PED-07/08/119 Hobbs C, Childs AM, Wynne J, Livingston J, Seal A (2005) Subdural haematoma and effusion in infancy: an epidemiological study. Arch Dis Child 90:952–955. https://doi.org/10.1136/adc.2003.037739 Hogberg U, Andersson J, Squier W, Hogberg G, Fellman V, Thiblin I, Wester K (2018) Epidemiology of subdural haemorrhage during infancy: a population-based register study. PLoS One 13:e0206340. https://doi.org/10.1371/journal.pone.0206340 Ingraham FD, Matson DD (1944) Subdural hematoma in infancy. J Pediatr 24:1–37 Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, Sibert JR, Kemp AM (1998) Subdural haemorrhages in infants: population based study. BMJ 317:1558–1561 Kapila A, Trice J, Spies WG, Siegel BA, Gado MH (1982) Enlarged cerebrospinal-fluid spaces in infants with subdural hematomas. Radiology 142:669–672 Kawakami Y, Chikama M, Tamiya T, Shimamura Y (1989) Coagulation and fibrinolysis in chronic subdural hematoma. Neurosurgery 25:25–29 Kramer K, Goldstein B (1993) Retinal hemorrhages following cardiopulmonary-resuscitation. Clin Pediatr 32:366–368. https://doi.org/10.1177/000992289303200610 Laubscher B, Deonna T, Uske A, van MG (1990) Primitive megalencephaly in children: natural history, medium term prognosis with special reference to external hydrocephalus. Eur J Pediatr 149:502–507 Lee HC, Chong S, Lee JY, Cheon JE, Phi JH, Kim SK, Kim IO, Wang KC (2018) Benign extracerebral fluid collection complicated by subdural hematoma and fluid collection: clinical characteristics and management. Childs Nerv Syst 34:235–245. https://doi.org/10.1007/s00381-017-3583-y Levin AV (2010) Retinal hemorrhage in abusive head trauma. Pediatrics 126:961–970. https://doi.org/10.1542/peds.2010-1220 Li LH, Li N, Zhao JY, Fei P, Zhang GM, Mao JB, Rychwalski PJ (2013) Findings of perinatal ocular examination performed on 3573, healthy full-term newborns. Brit J Ophthalmol 97:588–591. https://doi.org/10.1136/bjophthalmol-2012-302539 Libicher M, Troger J (1992) Us Measurement of the subarachnoid space in infants - normal values. Radiology 184:749–751 Looney CB, Smith JK, Merck LH, Wolfe HM, Chescheir NC, Hamer RM, Gilmore JH (2007) Intracranial hemorrhage in asymptomatic neonates: prevalence on MR images and relationship to obstetric and neonatal risk factors. Radiology 242:535–541. https://doi.org/10.1148/radiol.2422060133 Ludwig S, Warman M (1984) Shaken baby syndrome - a review of 20 cases. Ann Emerg Med 13:104–107. https://doi.org/10.1016/S0196-0644(84)80571-5 Maguire S, Pickerd N, Farewell D, Mann M, Tempest V, Kemp AM (2009) Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review. Arch Dis Child 94:860–867. https://doi.org/10.1136/adc.2008.150110 Maguire SA, Lumb RC, Kemp AM, Moynihan S, Bunting HJ, Watts PO, Adams GG (2013) A systematic review of the differential diagnosis of retinal haemorrhages in children with clinical features associated with child abuse. Child Abuse Rev 22:29–43. https://doi.org/10.1002/car.2224 Marino MA, Morabito R, Vinci S, Germano A, Briguglio M, Alafaci C, Mormina E, Longo M, Granata F (2014) Benign external hydrocephalus in infants. A single centre experience and literature review. Neuroradiol J 27:245–250. https://doi.org/10.15274/NRJ-2014-10020 McKeag H, Christian CW, Rubin D, Daymont C, Pollock AN, Wood J (2013) Subdural hemorrhage in pediatric patients with enlargement of the subarachnoid spaces Clinical article. J Neurosurg Pediatr 11:438–444. https://doi.org/10.3171/2012.12.PEDS12289 McNeely PD, Atkinson JD, Saigal G, O’Gorman AM, Farmer JP (2006) Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. Am J Neuroradiol 27:1725–1728 Medina LS, Frawley K, Zurakowski D, Buttros D, DeGrauw AJ, Crone KR (2001) Children with macrocrania: clinical and imaging predictors of disorders requiring surgery. AJNR Am J Neuroradiol 22:564–570 Miller D, Barnes P, Miller M (2015) The significance of macrocephaly or enlarging head circumference in infants with the triad further evidence of mimics of shaken baby syndrome. Am J Foren Med Path 36:111–120. https://doi.org/10.1097/Paf.0000000000000152 Mori K, Sakamoto T, Nishimura K, Fujiwara K (1993) Subarachnoid fluid collection in infants complicated by subdural-hematoma. Childs Nerv Syst 9:282–284. https://doi.org/10.1007/Bf00306274 Murakami H, Hirose Y, Sagoh M, Shimizu K, Kojima M, Gotoh K, Mine Y, Hayashi T, Kawase T (2002) Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. J Neurosurg 96:877–884. https://doi.org/10.3171/jns.2002.96.5.0877 Nemivant K, Bhalerao A (2015) Retinal haemorrhages in the newborn. J Evol Med Dental Sci Jemds 4:8028–8040. https://doi.org/10.14260/jemds/2015/1166 Nogueira GJ, Zaglul HF (1991) Hypodense extracerebral images on computed-tomography in children external hydrocephalus - a misnomer. Childs Nerv Syst 7:336–341. https://doi.org/10.1007/Bf00304833 Papasian NC, Frim DM (2000) A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma. Pediatr Neurosurg 33:188–193. https://doi.org/10.1159/000055951 Parulekar MV, Elston JS (2008) The evidence base for retinal haemorrhages in shaken baby syndrome. Dev Med Child Neurol 50:793–794 Pham H, Enzenauer RW, Elder JE, Levin AV (2013) Retinal hemorrhage after cardiopulmonary resuscitation with chest compressions. Am J Foren Med Path 34:122–124. https://doi.org/10.1097/PAF.0b013e31828c38f9 Piatt JH Jr (1999) A pitfall in the diagnosis of child abuse: external hydrocephalus, subdural hematoma, and retinal hemorrhages. Neurosurg Focus 7:e4 Pierre-Kahn V, Roche O, Dureau P, Uteza Y, Renier D, Pierre-Kahn A, Dufier JL (2003) Ophthalmologic findings in suspected child abuse victims with subdural hematomas. Ophthalmology 110:1718–1723. https://doi.org/10.1016/S0161-6420(03)00581-5 Polito A, Eong KGA, Repka MX, Pieramici DJ (2001) Bilateral retinal hemorrhages in a preterm infant with retinopathy at prematurity immediately following cardiopulmonary resuscitation. Arch Ophthalmol 119:913–914 Pu QL, Li P, Jiang HQ, Wang H, Zhou QY, Liu J, Zhong WH, Huang HF (2017) Factors related to retinal haemorrhage in infants born at high risk. Acta Ophthalmol 95:E477–E480. https://doi.org/10.1111/aos.13515 Ravid S, Maytal J (2003) External hydrocephalus: a probable cause for subdural hematoma in infancy. Pediatr Neurol 28:139–141. https://doi.org/10.1016/S0887-8994(02)00500-3 Rooks VJ, Eaton JP, Ruess L, Petermann GW, Keck-Wherley J, Pedersen RC (2008) Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. Am J Neuroradiol 29:1082–1089. https://doi.org/10.3174/ajnr.A1004 Sahar A (1978) Pseudohydrocephalus-megalocephaly, increased intracranial-pressure and widened subarachnoid space. Neuropadiatrie 9:131–139. https://doi.org/10.1055/s-0028-1085418 Sato S, Suzuki J (1975) Ultrastructural observations of capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 43:569–578. https://doi.org/10.3171/jns.1975.43.5.0569 SBU (2016 ) Traumatic shaking - the role of the triad in medical investigations of suspected traumatic shaking. A systematic review. Stockholm: Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU); SBU report no 255E, ISBN 978-91-85413-98-0:61 Scheller J (2017) Infantile retinal haemorrhages in the absence of brain and bodily injury. Acta Paediatr 106:1902–1904. https://doi.org/10.1111/apa.14043 Stridbeck US, Nilsson P, Wikström P, Wester K (2020) VURDERING AV FILLERISTING AV BARN I STRAFFESAKER FOR NORSKE DOMSTOLER. Tidsskrift for Rettsvitenskap 133:423–475. https://doi.org/10.18261/issn.1504-3096-2020-04-03 Thiblin I, Andersson J, Wester K, Wikstrom J, Hogberg G, Hogberg U (2020) Medical findings and symptoms in infants exposed to witnessed or admitted abusive shaking: a nationwide registry study. PLoS One 15:e0240182. https://doi.org/10.1371/journal.pone.0240182 Tucker J, Choudhary AK, Piatt J (2016) Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections. J Neurosurg Pediatr 18:16–20. https://doi.org/10.3171/2015.12.PEDS15600 Vinchon M, de Foort-Dhellemmes S, Desurmont M, Delestret I (2010) Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases. Childs Nerv Syst 26:637–645. https://doi.org/10.1007/s00381-009-1048-7 Vinchon M, Delestret I, DeFoort-Dhellemmes S, Desurmont M, Noule N (2010) Subdural hematoma in infants: can it occur spontaneously? Data from a prospective series and critical review of the literature. Childs Nerv Syst 26:1195–1205. https://doi.org/10.1007/s00381-010-1105-2 Vinekar A, Govindaraj I, Jayadev C, Kumar AK, Sharma P, Mangalesh S, Simaldi L, Avadhani K, Shetty B, Bauer N (2015) Universal ocular screening of 1021 term infants using wide-field digital imaging in a single public hospital in India - a pilot study. Acta Ophthalmol 93:E372–E376. https://doi.org/10.1111/aos.12685 Weigel R, Schilling L, Schmiedek P (2001) Specific pattern of growth factor distribution in chronic subdural hematoma (CSH): evidence for an angiogenic disease. Acta Neurochir 143:811–818. https://doi.org/10.1007/s007010170035 Wiig US, Zahl SM, Egge A, Helseth E, Wester K (2017) Epidemiology of benign external hydrocephalus in Norway a population-based study. Pediatr Neurol 73:36–41. https://doi.org/10.1016/j.pediatrneurol.2017.04.018 Wilms G, Vanderschueren G, Demaerel PH, Smet MH, Van Calenbergh F, Plets C, Goffin J, Casaer P (1993) CT and MR in infants with pericerebral collections and macrocephaly: benign enlargement of the subarachnoid spaces versus subdural collections. AJNR Am J Neuroradiol 14:855–860 Zaben M, Manivannan S, Petralia C, Leach P (2019) Subdural haematoma in neonates following forceps-assisted delivery: case series and review of the literature. Childs Nerv Syst 35:403–409. https://doi.org/10.1007/s00381-018-04043-6 Zahl SM, Egge A, Helseth E, Wester K (2011) Benign external hydrocephalus: a review, with emphasis on management. Neurosurg Rev 34:417–432. https://doi.org/10.1007/s10143-011-0327-4 Zahl SM, Egge A, Helseth E, Wester K (2019) Clinical, radiological, and demographic details of benign external hydrocephalus: a population-based study. Pediatr Neurol 96:53–57. https://doi.org/10.1016/j.pediatrneurol.2019.01.015 Zahl SM, Wester K, Gabaeff S (2020) Examining perinatal subdural haematoma as an aetiology of extra-axial hygroma and chronic subdural haematoma. Acta Paediatr 109:659–666. https://doi.org/10.1111/apa.15072