Subdural haematoma and non-accidental head injury in children

Childs Nerv Syst. 2002 Jul;18(6-7):311-7. doi: 10.1007/s00381-002-0616-x. Epub 2002 Jun 26.


Patients and methods: In this retrospective study, 36 children referred to paediatric neurology and neurosurgery during April 1995-June 1998 with a diagnosis of subdural haematoma (SDH) were studied. Nine were accidental secondary to witnessed trauma and 4 were iatrogenic. Non-accidental head injury (NAHI) was suspected in the remaining 23 children.

Results: After a full clinical, radiological and social assessment, NAHI was diagnosed in 14, lateral sinus thrombosis in 1, 2 were accepted as accidental and 6 remained unexplained. In the NAHI group (n=14), 12 were between 4 and 16 weeks of age, 12 (85%) had retinal haemorrhages and skeletal surveys showed evidence of additional injury in 8. Computerised tomography (CT) brain scans showed bilateral SDH in 11, and 6 had inter-hemispheric bleeding along with loss of grey-white differentiation. Eleven had magnetic resonance imaging (MRI), which yielded additional information in 7. Seven required intensive care, and 2 died. Twelve had surgical aspiration. In the group with no satisfactory explanation for SDH ( n=6); 5 had neonatal problems, all except 1 were older than 5 months of age and not as ill with bilateral, old SDH. All but 1 had skeletal surveys, which were normal, and eye examination showed no retinal haemorrhages. A social services enquiry was non-contributory.

Conclusions: SDH is frequently traumatic whether accidental or non-accidental. SDH due to NAHI tends to present before 4 months of age with an inconsistent history; the patients are more seriously ill and have other findings, such as fractures and retinal haemorrhages. A small subgroup of patients was identified who had isolated, old SDH and in whom full investigation remained inconclusive. A consistent, comprehensive approach needs to be maintained in all cases with the essential backup of detailed neuro-imaging including MRI.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Brain Injuries / diagnosis*
  • Brain Injuries / etiology
  • Child
  • Child Abuse
  • Child, Preschool
  • Craniocerebral Trauma / complications
  • Craniocerebral Trauma / diagnosis*
  • Hematoma, Subdural / diagnosis*
  • Hematoma, Subdural / etiology
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging / methods
  • Retrospective Studies