International Journal of Legal Medicine

, Volume 133, Issue 2, pp 539–546 | Cite as

Histological dating of subdural hematoma in infants

  • Clémence DelteilEmail author
  • Sarah Humez
  • Mohamed Boucekine
  • Anne Jouvet
  • Valery Hedouin
  • Laurent Fanton
  • Georges Leonetti
  • Lucile Tuchtan
  • Marie-Dominique Piercecchi
Original Article



After infant deaths due to non-accidental head injury (NAHI) with subdural hematoma (SDH), the magistrates ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of NAHI. We aimed to develop an SDH dating system applicable to infants aged under 3 years.

Methods and results

We studied a retrospective multicenter collection of 235 infants who died between the ages of 0 and 36 months, diagnosed with SDH by forensic pathological examination and with known posttraumatic interval (PTI). Two pathologists assessed blindly and independently 12 histomorphological criteria relating to the clot and 14 relating to the dura mater in 73 victims (31 girls, 42 boys) whose median age was 3.8 months. Histopathological changes were significantly correlated with PTI for the appearance of red blood cells (RBCs) and the presence or absence of siderophages, and regarding the dura mater, the quantity of lymphocytes, macrophages, and siderophages; presence or absence of hematoidin deposits; collagen and fibroblast formation; neomembrane thickness; and presence or absence of neovascularization. Dating systems for SDH in adults are not applicable to infants. Notably, neomembrane of organized connective tissue is formed earlier in infants than in adults.


Our dating system improves the precision and reliability of forensic pathological expert examination of NAHI, particularly for age estimation of SDH in infants. However, the expert can only define a time interval. Histopathology is indispensable to detect repetitive trauma.


Shaken baby syndrome Dating Histology Subdural hematoma Age estimation Posttraumatic interval 



Non-accidental head injury


Posttraumatic interval


Subdural hematoma


Red blood cells


Polymorphonuclear neutrophils


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

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ESM 1 (DOCX 19 kb)
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Qualitative classification of RBCs, from left to right: HES × 40. a Intact (discoid shape with a distinct contour and uniform staining); b Lysed cells (blurred contours, non-uniform staining): minimal lysis; c Distinct lysis; d Mixed. (PNG 8587 kb)

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High Resolution Image (TIFF 18688 kb)
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Semi-quantitative classification of PMNs: a No or very rare neutrophils, HES × 20; b Up to three clumps, HES × 20; c More than three clumps, HES × 20; d: Diffuse, HES × 20. (PNG 8941 kb)

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Qualitative classification of neovascularization: a Capillary proliferation, HES × 10; b Giant capillaries, HES × 10; c Arterioles, HES × 20 (PNG 20735 kb)

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Most important histological features over time. a Lysed red cells from 2 days onward, HES × 10; b Siderophages at 3 days in the dura mater and the clot, HES × 10; c Hemosiderin deposit from 12 days onward in the dura mater, Perls stain × 40, fibrinous organization; d Presence of fibroblasts and collagen from 3 days onward, HES × 30; e Neomembrane formation from 4 days onward, HES × 5; f neovascularization from 6 days onward, HES × 10. (PNG 3756 kb)

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High Resolution Image (TIFF 8366 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Clémence Delteil
    • 1
    • 2
    Email author
  • Sarah Humez
    • 3
  • Mohamed Boucekine
    • 4
  • Anne Jouvet
    • 5
  • Valery Hedouin
    • 6
  • Laurent Fanton
    • 7
  • Georges Leonetti
    • 1
    • 2
  • Lucile Tuchtan
    • 1
    • 2
  • Marie-Dominique Piercecchi
    • 1
    • 2
  1. 1.Forensic DepartmentAPHMMarseille, Cedex 05France
  2. 2.Aix-Marseille University, CNRS, EFS, ADESMarseilleFrance
  3. 3.Pathology DepartmentUniversity Hospital of LilleLilleFrance
  4. 4.Public Health Research Unit EA 3279Aix-Marseille UniversityMarseilleFrance
  5. 5.Pathology DepartmentUniversity Hospital of Lyon-EstBronFrance
  6. 6.Forensic Department and Social MedicineFaculty of Medicine of LilleLille CedexFrance
  7. 7.Forensic DepartmentLyon 03France

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