Introduction
Materials and methods
Case selection
Case | Age | Sex | Cause of death/associated features | No. of veins | SDH |
---|---|---|---|---|---|
Neonatal group (˂ 28 days) | |||||
1 | 36 + 3 weeks GA | M | HIE | 53 | N |
2 | 1 day | M | Birth trauma | n/a | Y |
3 | 1 day | F | Pulmonary haemorrhage | n/a | N |
4 | 1 day | F | Birth trauma, subgaleal haemorrhage | 67 | Y |
5 | 1 day | F | Perinatal asphyxiation and head injury | 30 | Y |
6 | 1 day | M | Perinatal head trauma | 45 | Y |
7 | 3 days | M | HIE, perinatal asphyxiation, uteroplacental insufficiency | 71 | N |
8 | 3 days | M | HIE, uteroplacental insufficiency and ruptured vasa previa | 45 | N |
9 | 3 days | F | Pulmonary haemorrhage; subtle congenital anomalies | 51 | N |
10 | 3 days | M | Persistent pulmonary hypertension of the newborn, patent ductus arteriosus | 51 | N |
11 | 6 days | M | Bowel perforation, perinatal head trauma | 33 | Y |
12 | 8 days | F | Lung dysplasia | 64 | N |
13 | 12 days | F | Positional asphyxia, co-sleeping | 56 | Y |
14 | 17 days | M | HSV infection | 54 | N |
15 | 24 days | M | Pulmonary haemorrhage | 43 | N |
16 | 26 days | F | Unascertained, SUDI, co-sleeping | 58 | N |
Infant group (4 weeks to 1 year) | |||||
17 | 4 weeks | M | Pulmonary haemorrhage | 66 | Y |
18 | 4 weeks | M | Unascertained, SUDI | 62 | Y |
19 | 4 weeks | M | Ruptured cerebrovascular malformation | 57 | Y |
20 | 4 weeks | F | Multiple organ failure, complex congenital heart disease | n/a | N |
21 | 6 weeks | F | Unascertained, co-sleeping, possible positional asphyxiation | 48 | N |
22 | 8 weeks | M | SIDS | 57 | N |
23 | 8 weeks | M | Unascertained, SUDI, co-sleeping | 51 | N |
24 | 9 weeks | F | SIDS | 60 | N |
25 | 9 weeks | M | AHT | 27 | Y |
26 | 9 weeks | M | External airway obstruction, co-sleeping | 58 | N |
27 | 9 weeks | M | Unascertained, SUDI, co-sleeping | 50 | N |
28 | 14 weeks | M | Overlaying, minor crush injury to head, co-sleeping | 71 | Y |
29 | 15 weeks | M | SIDS | 56 | N |
30 | 15 weeks | M | SIDS | 63 | N |
31 | 16 weeks | F | Positional asphyxia, restrictive seating device | 39 | N |
32 | 17 weeks | M | AHT | 30 | Y |
33 | 21 weeks | M | SIDS | 49 | N |
34 | 23 weeks | F | Unascertained, SUDI, co-sleeping | 40 | N |
35 | 25 weeks | M | Unascertained, SUDI, co-sleeping | 85 | N |
36 | 27 weeks | F | Dog attack, head injury | 44 | N |
37 | 29 weeks | F | Smoke inhalation | 54 | N |
38 | 31 weeks | F | AHT | 34 | Y |
39 | 43 weeks | F | Unascertained, SUDI, co-sleeping | 58 | N |
40 | 45 weeks | M | RSV bronchiolitis | 69 | N |
Young children (≤ 3 years) | |||||
41 | 13 months | F | Unascertained, possible external airway obstruction | 94 | N |
42 | 14 months | M | HIE, cause unascertained | 75 | N |
43 | 18 months | F | Unascertained, SUDI, prone sleeping, recurrent febrile convulsions | 36 | N |
44 | 18 months | M | Unascertained, SUDIC | 52 | N |
45 | 18 months | M | Aspiration of a foreign object and viral bronchiolitis (RSV and parainfluenza virus, type 4 positive) | n/a | N |
46 | 20 months | F | Sharp force extracranial trauma | 45 | N |
47 | 25 months | M | Bronchopneumonia, viral respiratory tract infection, recurrent febrile convulsions | n/a | N |
48 | 29 months | M | Cystic encephalomalacia and epilepsy | 75 | N |
Abusive head trauma cases
Case 25
Case number from Table 1
| Age | Description of cranial SDH | Mode of delivery for babies ≤ 4 weeks |
---|---|---|---|
2 | 1 day | Thin patchy smear over entire convexity and within interhemispheric fissure. Thin film over supratentorial, middle fossa and cerebellar surfaces. Thicker film within posterior fossa | Normal vaginal delivery |
4 | 1 day | Focal thin smear over the posterior parietal and occipital lobes. Focal thin film over the cerebellum | Caesarean section following failed ventouse delivery |
5 | 1 day | Extensive, thick, space occupying, extending over entire convexities, within all fossae, both supra- and subtentorial. Thin film over cerebellar surface | Forceps delivery |
6 | 1 day | Thin focal smear over right occipital lobe and underneath right occipital/temporal lobes. Thin film over surface of cerebellum and within the posterior fossa | Normal vaginal delivery |
11 | 6 days | Thin smear covering right/left parietal, occipital and temporal lobes. Thin patchy supratentorial and within interhemispheric fissure. Extremely thin smear within middle fossa. Slightly thicker film within posterior fossa and over surface of cerebellum | Ventouse delivery |
13 | 12 days | Thin smear of blood right/left occipital lobes | Forceps delivery |
17 | 4 weeks | Extremely thin smear of focal blood over right/left occipital lobes. Small focal patches of old SDH under tentorium, occipital dura, supratentorial and within the interhemispheric fissure | Normal vaginal delivery |
18 | 4 weeks | Trivial thin smear over left occipital lobe and surface of the cerebellum | Normal vaginal delivery |
19 | 4 weeks | Intraventricular haemorrhage. Thin film of patchy SDH around right temporal pole, within interhemispheric fissure, over tentorium and under left temporal lobe. Thick SDH within the middle and posterior fossa | Normal vaginal delivery |
25 | 9 weeks | Bilateral patchy thin film, thickest over sulci of brain with extremely thin bleeding over gyral convexities. Thicker blood over parietal/occipital lobes. SDH within interhemispheric fissure. Small smear of blood over surface of cerebellum | n/a |
28 | 14 weeks | Patchy, extremely thin, over right convexity. Thin smears over right tentorium and falx | n/a |
32 | 17 weeks | Bilateral patchy thin film, thickest over sulci of brain with extremely thin bleeding over gyral convexities. Thicker blood over frontal lobes and left parietal lobe. SDH in interhemispheric fissure and all cranial fossae | n/a |
38 | 31 weeks | Bilateral patchy thin film, thickest over sulci of brain with extremely thin bleeding over gyral convexities. Thicker density of blood over left parietal lobe. SDH within interhemispheric fissure and middle/posterior fossae | n/a |
Case 32
Case 38
Post-mortem visualisation of the bridging veins and subdural haemorrhage
Magnetic resonance imaging of an infant brain
Segmentation of the brain using ITK-SNAP
Creation of a Matlab Interface for plotting bridging vein locations on a 3D infant brain model
Macrophotography and measurement of bridging veins
Results
Post-mortem visualisation of the bridging veins and subdural haemorrhage
3D mapping of the bridging veins
Number of bridging veins
Outer diameter of infant bridging veins
Bridging vein location | Number (n) | Mean diameter (mm) |
---|---|---|
Right frontal convexity | 1 | 0.53 |
Left frontal convexity | 4 | 0.94 |
Right frontal parasagittal | 13 | 0.83 |
Left frontal parasagittal | 10 | 0.92 |
Right parietal convexity | 1 | 0.05 |
Left parietal convexity | 0 | n/a |
Right parietal parasagittal | 22 | 0.87 |
Left parietal parasagittal | 14 | 1.38 |
Interhemispheric fissure | 6 | 0.73 |
Cerebellum | 8 | 0.74 |
Total | 79 | 0.93 |