Test 10

  • Michael Paddock
  • Amaka C. Offiah


CT of the head showed subdural haemorrhage in the posterior fossa and the right side of the falx; no other brain injury or acute intracranial haemorrhage was demonstrated. Subdural haemorrhages can be found in neonates on imaging following delivery, both normal vaginal and assisted (forceps/ventouse) but are usually ‘clinically silent’ and when present in asymptomatic infants are usually infratentorial in location and usually resolve by 4 weeks following delivery. This is contrasted with the pattern of subdural haemorrhage found in inflicted injury which is typically supratentorial—bilateral or interhemispheric. The infratentorial haemorrhage in this child had resolved on the MRI performed 2 days later and imaging of the spine was normal. It is imperative that cross-sectional imaging of the neuroaxis (i.e. of the brain and spine) is performed in the imaging investigation of suspected physical abuse, as recommended in the national guidance. Investigation with initial and follow-up skeletal survey did not reveal any other acute or healing fractures. It was felt that this fracture, whilst unexplained, alongside the pattern of intracranial haemorrhage, was probably sustained at the time of delivery.


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Further Reading

Image 12

  1. Hui C, Joughin E, Goldstein S et al (2008) Femoral fractures in children younger than three years: the role of nonaccidental injury. J Pediatr Orthop 28:297–302CrossRefGoogle Scholar
  2. Kemp AM, Dunstan F, Harrison S et al (2008) Patterns of skeletal fractures in child abuse: systematic review. BMJ 337:a1518CrossRefGoogle Scholar
  3. Schwend RM, Werth C, Johnston A (2000) Femur shaft fractures in toddlers and young children: rarely from child abuse. J Pediatr Orthop 20:475–481PubMedGoogle Scholar
  4. Thomas SA, Rosenfield NS, Leventhal JM et al (1991) Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics 88:471–476PubMedGoogle Scholar

Image 18

  1. Whitby EH, Griffiths PD, Rutter S et al (2004) Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 363(9412):846–851CrossRefGoogle Scholar

Image 23

  1. Luijkx T, Gaillard F et al (2018) Galeazzi fracture-dislocation. Accessed August 2018

Image 27

  1. Choi HJ, Kim YH (2016) Apparent life-threatening event in infancy. Korean J Pediatr 59(9):347–354CrossRefGoogle Scholar
  2. Jobe AH (2008) What is ALTE? J Pediatr 152(3):A2CrossRefGoogle Scholar
  3. Tate C, Sunley R (2018) Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Arch Dis Child Educ Pract Ed 103(2):95–98CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Michael Paddock
    • 1
  • Amaka C. Offiah
    • 2
  1. 1.Sheffield Teaching HospitalsSheffieldUK
  2. 2.Academic Unit of Child Health, Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK

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