Thin-films of subdural hemorrhage in the absence of mechanical trauma: the new challenge of an expanding differential

Excerpt

The recent article by Mack et al. [1] “Anatomy and development of the meninges: implications for subdural collections and CSF circulation” and the included commentaries by Nelson [2] and by Slovis and Chapman [3] were bold, and I applaud the editors of Pediatric Radiology for their willingness to publish an article which may spark controversy, but may also represent a paradigm shift in our approach to these cases of infants with unexpected thin-films of subdural blood. The hypothesis that all subdural bleeding results from torn bridging veins has for years been the dominant thought. Unless specific conditions could be identified such as severe coagulopathy, benign extraaxial collections, rebleed from an existing neomembrane of a chronic subdural collection, or glutaric aciduria type 1, blunt force trauma was assumed. However, in many of the cases on which I have consulted, the situation was acute, and unfolded with such rapidity to a fatal outcome that adequate evaluation for even these alternative explanations was not possible. …