Skip to main content

Post-mortem Examination of Infant Bridging Veins and Subdural Haemorrhage

  • Chapter
  • First Online:
  • 542 Accesses

Abstract

This chapter details an alternative and improved approach to removal of the calvarial bones using neurosurgical equipment during neonatal, infant and young child post-mortem examinations. This method leaves the dura mater intact and reduces post-mortem artefact. A technique known as optical clearing is also described which increases the transparency of the dura and improves photographical documentation of bleeding below the membrane. Using these techniques, the authors describe the patterns of subdural haemorrhage and associated cranial injuries seen in paediatric head injury. Further, a detail anatomical description of infant bridging veins is also provided.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, Sibert JR, Kemp AM. Subdural haemorrhages in infants: population based study. BMJ. 1998;317:1558–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Minns A, Lo TYM. Head and neck injuries. In: Busuttil A, Keeling JW, editors. Pediatric forensic medicine and pathology. London: Hodder Arnold; 2009. p. 295.

    Google Scholar 

  3. Kemp AM. Abusive head trauma: recognition and the essential investigation. Arch Dis Child Educ Pract Ed. 2011;96:202–8.

    Article  PubMed  Google Scholar 

  4. Piteau SJ, Ward MGK, Barrowman NJ, Plint AC. Clinical and radiographic characteristics associated with abusive and non-abusive head trauma: a systematic review. Pediatrics. 2012;130:315–23.

    Article  PubMed  Google Scholar 

  5. Choudhary AK, Ishak R, Zacharia TT, Dias MS. Imaging of spinal injury in abusive head trauma: a retrospective study. Pediatr Radiol. 2014;44:1130–40.

    Article  PubMed  Google Scholar 

  6. Case ME, Graham MA, Handy TC, Jentzen JM, Monteleone JA. Position paper on fatal abusive head injuries in infants and young children. Am J Forensic Med Pathol. 2001;22:112–22.

    Article  CAS  PubMed  Google Scholar 

  7. Case ME. Abusive head injuries in infants and young children. Leg Med (Tokyo). 2007;9:83–7.

    Article  Google Scholar 

  8. Dunham C, Perry A. The nervous system. In: Stocker JT, Dehner LP, Husain AN, editors. Pediatric Pathology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 357.

    Google Scholar 

  9. Garrett D, 2013. National center for prosecution of child abuse, overcoming defense expert testimony in abusive head trauma cases. Available from http://www.ndaa.org/pdf/Abusive%20HeadTrauma_NDAA.pdf. Accessed 15 Feb 2019.

  10. Collins P. Neonatal anatomy and growth. In: Williams PL, et al., editors. Gray’s anatomy: the anatomical basis of medicine and surgery. 38th ed. New York: Churchill Livingstone; 1995. p. 354.

    Google Scholar 

  11. Hayden L, Kulak D, Maxwell F, Wentzkes S. Osteopathic diagnosis. In: Moeckel E, Mitha N, editors. Textbook of pediatric osteopathy. Edinburgh: Churchill Livingstone; 2008. p. 123.

    Google Scholar 

  12. Amiel-Tison C, Gosselin J, Infante-Rivard C. Head growth and cranial assessment at neurological examination in infancy. Dev Med Child Neurol. 2002;44:643–8.

    Article  PubMed  Google Scholar 

  13. Okazaki H, Campbell RJ. Nervous system. In: Ludwig J, editor. Current methods of autopsy practice. Philadelphia: W B Saunders Company; 1979. p. 97–8.

    Google Scholar 

  14. Riezzo I. Pediatric and fetal autopsies. In: Pomara C, Karch SB, Fineschi V, editors. Forensic autopsy: a handbook and atlas. Florida. Florida: CRC Press; 2010. p. 79–83.

    Chapter  Google Scholar 

  15. Cheshire EC, Malcomson RDG, Rutty GN, James DS. Visualisation of the intact dura mater and brain surface in infant autopsies: a minimally destructive technique for the post-mortem assessment of head injury. Int J Legal Med. 2015;129:307–12.

    Article  PubMed  Google Scholar 

  16. Cheshire EC, Malcomson RDG, Joseph S, Biggs MJB, Adlam D, Rutty GN. Optical clearing of the dura mater using glycerol: a reversible process to aid the post-mortem investigation of infant head injury. Forensic Sci Med Pathol. 2015;11:395–404.

    Article  CAS  PubMed  Google Scholar 

  17. Leary T. Subdural hemorrhages. JAMA. 1934;103:897–903.

    Article  Google Scholar 

  18. Cabot RC, Mallory TB. Case 26512. N Engl J Med. 1940;223:1030–3.

    Article  Google Scholar 

  19. Trotter W. Chronic subdural hemorrhage of traumatic origin, and its relation to pachymeningitis hemorrhagica interna. Br J of Neurosurg. 1914;2:271–91.

    Google Scholar 

  20. Gennarelli TA, Thibault LE. Biomechanics of acute subdural hematoma. J Trauma. 1982;22:680–6.

    Article  CAS  PubMed  Google Scholar 

  21. Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg. 1987;66:409–15.

    Article  CAS  PubMed  Google Scholar 

  22. Maxeiner H. Detection of ruptured cerebral bridging veins at autopsy. Forensic Sci Int. 1997;89:103–10.

    Article  CAS  PubMed  Google Scholar 

  23. Rambaud C. Bridging veins and autopsy findings in abusive head trauma. Pediatr Radiol. 2015;45:1126–31.

    Article  PubMed  Google Scholar 

  24. Ehrlich E, Maxeiner H, Lange J. Postmortem radiological investigation of bridging vein ruptures. Leg Med (Tokyo). 2003;5(Suppl 1):S225–7.

    Article  Google Scholar 

  25. Yamashima T, Friede RL. Why do bridging veins rupture into the virtual subdural space? J Neurol Neurosurg Psychiatry. 1984;47:121–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Han H, Tao W, Zhang M. The dural entrance of cerebral bridging veins into the superior sagittal sinus: an anatomical comparison between cadavers and digital subtraction angiography. Neuroradiology. 2007;49:169–75.

    Article  PubMed  Google Scholar 

  27. Brockmann C, Kunze SC, Schmiedek P, Groden C, Scharf J. Variations of the superior sagittal sinus and bridging veins in human dissections and computed tomography venography. Clin Imaging. 2012;36:85–9.

    Article  PubMed  Google Scholar 

  28. Andrews BT, Dujovny M, Mirchandani HG, Ausman JI. Microsurgical anatomy of the venous drainage into the superior sagittal sinus. Neurosurgery. 1989;24:514–20.

    Article  CAS  PubMed  Google Scholar 

  29. Cheshire EC, Malcomson RDG, Sun P, Mirkes EM, Amoroso JM, Rutty GN. A Systematic Autopsy Survey of Human Infant Bridging Veins. Int J Legal Med. 2018;132:449–61.

    Article  PubMed  Google Scholar 

  30. Nierenberger M, Wolfram-Gabel R, Decock-Catrin S, Boehm N, Rémond Y, Kahn JL, Ahzi S. Investigation of the human bridging veins structure using optical microscopy. Surg Radiol Anat. 2013;35:331–7.

    Article  PubMed  Google Scholar 

  31. Finnie JW, Blumbergs PC, Manavis J, Turner RJ, Helps S, Vink R, Byard RW, Chidlow G, Sandoz B, Dutschke J, Anderson RW. Neuropathological changes in a lamb model of non-accidental head injury (the shaken baby syndrome). J Clin Neurosci. 2012;19:1159–64.

    Article  CAS  PubMed  Google Scholar 

  32. Vignes JR, Dagain A, Guérin J, Liguoro D. A hypothesis of cerebral venous system regulation based on a study of the junction between the cortical bridging veins and the superior sagittal sinus. J Neurosurg. 2007;107:1205–10.

    Article  PubMed  Google Scholar 

  33. Vlasyuk VV. Birth trauma and perinatal brain damage. Switzerland: Springer Nature; 2019. p. 31–93.

    Book  Google Scholar 

  34. Rooks VJ, Eaton JP, Ruess L, Petermann GW, Keck-Wherley J, Pedersen RC. Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. Am J Neuroradiol. 2008;29:1082–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kemp AM, Stoodley N, Cobley C, Coles L, Kemp KW. Apnoea and brain swelling in non-accidental head injury. Arch Dis Child. 2003;88:472–6;discussion 472–6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Rorke-Adams L, Duhhaime CA, Jenny C, Smith WL, Trauma H. In: Reece RM, Christian CW, editors. Child abuse; medical diagnosis & management. 3rd ed. Illinois: American Academy of Pediatrics; 2009. p. 61–84.

    Google Scholar 

  37. Roach JP, Acker SN, Bensard DD, Sirotnak AP, Karrer FM, Partrick DA. Head injury pattern in children can help differentiate accidental from non-accidental trauma. Pediatr Surg Int. 2014;30:1103–6.

    Article  PubMed  Google Scholar 

  38. Ewing-Cobbs L, Prasad M, Kramer L, Louis PT, Baumgartner J, Fletcher JM, Alpert B. Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Childs Nerv Syst. 2000;16:25–34.

    Article  CAS  PubMed  Google Scholar 

  39. King WJ, MacKay M, Sirnick A. Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases. CMAJ. 2003;168:155–9.

    PubMed  PubMed Central  Google Scholar 

  40. Geddes JF, Vowles GH, Hackshaw AK, Nickols CD, Scott IS, Whitwell HL. Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain. 2001;124:1299–306.

    Article  CAS  PubMed  Google Scholar 

  41. Matschke J, Buttner A, Bergmann M, Hagel C, Puschel K, Glatzel M. Encephalopathy and death in infants with abusive head trauma is due to hypoxic-ischemic injury following local brain trauma to vital brainstem centers. Int Legal Med. 2015;129:105–14.

    Article  Google Scholar 

  42. Case ME. Distinguishing accidental from inflicted head trauma at autopsy. Pediatr Radiol. 2014;44(Suppl 4):S632–40.

    Article  PubMed  Google Scholar 

  43. Corey TS, Collins KA. Pediatric forensic pathology. In: Stocker JT, Dehner LP, Husain AN, editors. Pediatric pathology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 273.

    Google Scholar 

  44. Grey TC. Unintentional head injuries: case studies. In: Frasier L, Rauth-Farley K, Alexander R, Parrish R, editors. Abusive head trauma in infants and children; a medical, legal and forensic reference. Missouri: G.W. Medical Publishing, Inc; 2006. p. 19–27.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emma C. Cheshire .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cheshire, E.C., Harris, N.C. (2019). Post-mortem Examination of Infant Bridging Veins and Subdural Haemorrhage. In: Rutty, G. (eds) Essentials of Autopsy Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-24330-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-24330-2_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24329-6

  • Online ISBN: 978-3-030-24330-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics