Article Figures & Data
Figures
- Fig 1.
Two-month-old boy with huge hypodense, CSF-like, subdural collections lacking encapsulating membranes (A, cranial CT). MR imaging confirmed the diagnosis of frontoparietal SDHys on both sides (B, axial T2-weighted image; C, coronal T2-weighted image).
- Fig 2.
Simplified schematic drawing of the pathogenetic pathways of the origin and fate of SDHys. ICP indicates intracranial pressure.
- Fig 3.
MR imaging scan of a 5-month-old female infant who showed a sudden increase of head circumference (from 50th to 97th percentile within 1 month). Frontoparietal SDHys (maximum width of 11 mm) as well as enlarged subarachnoid spaces (maximum width of 4 mm) were found on both sides (A, sagittal T1-weighted image; B, axial T2-weighted image; thin arrows indicate position of the subarachnoid membrane). In addition, a small subacute SDH was diagnosed in the left posterior cranial fossa beneath the tentorium cerebelli (A, small thick arrows indicate subdural blood). In the preceding months, periodic sonography scans of the head did not ever show any abnormalities with respect to the subdural or subarachnoidal space. Ophthalmologic examination revealed sub- and epiretinal hemorrhages distributed over the whole fundus area of both eyes. These retinal hemorrhages were not present yet in a check-up examination 1 month after birth. As further clinical diagnostics have ruled out coagulopathies, neoplastic diseases, and metabolic disorders, the presence of SDH and retinal hemorrhage prove substantial (sub)acute head trauma and therefore strongly suggest child abuse (AHT). The enlarged subarachnoid spaces, found after the trauma diagnosis, have rather to be regarded as consequence and not as source (see “BESS” section). Hence, the SDHy in this well-documented case can be regarded as a result of acute injury.
- Fig 4.
Benign enlargement of the subarachnoid space. While in CT (A), BESS could be misdiagnosed as SDHy, MR imaging (B, T1-weighted image; C, T2-weighted image) clearly demonstrates the presence of BESS. Note the vessels (thin arrows) spanning through the subarachnoid space. The small black arrows in B point at the subarachnoid membrane.
- Fig 5.
Schematic drawing of the right parietal region as seen in the coronal view imaging. Note the position of the subarachnoid membrane and the subarachnoid vessels (both in yellow). The dura mater is presented in green. A, normal situation; B, enlarged subarachnoid spaces and C, subdural hygroma.
