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Influence of the benign enlargement of the subarachnoid space on the bridging veins strain during a shaking event: a finite element study

  • Jean-Sébastien Raul
  • Sébastien Roth
  • Bertrand Ludes
  • Rémy Willinger
Technical Note

Abstract

There is controversy regarding the influence of the benign enlargement of the subarachnoid space on intracranial injuries in the field of the shaken baby syndrome. In the literature, several terminologies exists to define this entity illustrating the lack of unicity on this theme, and often what is “benign” enlargement is mistaken with an old subdural bleeding or with abnormal enlargement due to brain pathology. This certainly led to mistaken conclusions. To investigate the influence of the benign enlargement of the subarachnoid space on child head injury and especially its influence on the bridging veins, we used a finite element model of a 6-month-old child head on which the size of the subarachnoid space was modified. Regarding the bridging veins strain, which is at the origin of the subdural bleeding when shaking an infant, our results show that the enlargement of the subarachnoid space has a damping effect which reduces the relative brain/skull displacement. Our numerical simulations suggest that the benign enlargement of the subarachnoid space may not be considered as a risk factor for subdural bleeding.

Keywords

Finite element model Shaken baby syndrome Benign enlargement of the subarachnoid space Child abuse 

References

  1. 1.
    Briner S, Bodensteiner J (1981) Benign subdural collections of infancy. Pediatrics 67(6):802–804PubMedGoogle Scholar
  2. 2.
    Azais M, Echenne B (1992) Idiopathic pericerebral swelling (external hydrocephalus) of infants. Ann Pediatr (Paris) 39(9):550–558, NovGoogle Scholar
  3. 3.
    Kleinman PK, Zito JL, Davidson RI, Raptopoulos V (1983) The subarachnoid spaces in children: normal variations in size. Radiology 147(2):455–457, MayPubMedGoogle Scholar
  4. 4.
    Veyrac C, Couture A, Baud C (1990) Pericerebral fluid collections and ultrasound. Pediatr Radiol 20(4):236–240PubMedCrossRefGoogle Scholar
  5. 5.
    Wilms G, Vanderschueren G, Demaerel PH, Smet MH, Van Calenbergh F, Plets C, Goffin J, Casaer P (1993) CT and MR in infants with pericerebral collections and macrocephaly: benign enlargement of the subarachnoid spaces versus subdural collections. AJNR Am J Neuroradiol 14(4):855–860, Jul-AugPubMedGoogle Scholar
  6. 6.
    Aoki N (1994) Accidental head trauma and retinal hemorrhage. Neurosurgery 34(4):771, AprPubMedCrossRefGoogle Scholar
  7. 7.
    Aoki N, Masuzawa H (1984) Infantile acute subdural hematoma. Clinical analysis of 26 cases. J Neurosurg 61(2):273–280, AugPubMedGoogle Scholar
  8. 8.
    Howard MA, Bell BA, Uttley D (1993) The pathophysiology of infant subdural haematomas. Br J Neurosurg 7(4):355–365PubMedCrossRefGoogle Scholar
  9. 9.
    Ikeda A, Sato O, Tsugane R, Shibuya N, Yamamoto I, Shimoda M (1987) Infantile acute subdural hematoma. Childs Nerv Syst 3(1):19–22PubMedCrossRefGoogle Scholar
  10. 10.
    Kapila A, Trice J, Spies WG, Siegel BA, Gado MH (1982) Enlarged cerebrospinal fluid spaces in infants with subdural hematomas. Radiology 142(3):669–672, MarPubMedGoogle Scholar
  11. 11.
    McNeely PD, Atkinson JD, Saigal G, O’Gorman AM, Farmer JP (2006) Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. AJNR Am J Neuroradiol 27(8):1725–1728, SepPubMedGoogle Scholar
  12. 12.
    Roth S, Raul JS, Ludes B, Willinger R (2007) Finite element analysis of impact and shaking inflicted to a child. Int J Legal Med 121(3):223–228, MayPubMedCrossRefGoogle Scholar
  13. 13.
    Raul JS, Deck C, Willinger R, Ludes B (2008) Finite element models of the human head and their applications in forensic practice. Int J Legal Med (in press)Google Scholar
  14. 14.
    Roth S, Raul JS, Willinger R (2008) Biofidelic child head FE model to simulate real world trauma. Comput Methods Programs Biomed 90(3):262–274, JunGoogle Scholar
  15. 15.
    Raul JS, Deck C, Meyer F, Geraut A, Willinger R, Ludes B (2007) A finite element model investigation of gunshot injury. Int J Legal Med 121(2):143–146, MarPubMedCrossRefGoogle Scholar
  16. 16.
    Raul JS, Baumgartner D, Willinger R, Ludes B (2006) Finite element modelling of human head injuries caused by a fall. Int J Legal Med 120(4):212–218, JulPubMedCrossRefGoogle Scholar
  17. 17.
    Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R (1987) The shaken baby syndrome. A clinical, pathological and biomechanical study. J Neurosurg 66:409–415PubMedGoogle Scholar
  18. 18.
    Prange MT, Coats B, Duhaime AC, Margulies SS (2003) Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants. J Neurosurg 99:143–150PubMedCrossRefGoogle Scholar
  19. 19.
    Yamashima T, Friede RL (1984) Why do bridging veins rupture into the virtual subdural space? J Neurol Neurosurg Psychiatry 47(2):121–127, FebPubMedGoogle Scholar
  20. 20.
    Hymel KP, Jenny C, Block RW (2002) Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: addressing the forensic controversies. Child Maltreat 7(4):329–348, NovPubMedCrossRefGoogle Scholar
  21. 21.
    Kleinman PK, Barnes PD (1998) Head trauma. In: Kleinman PK (ed) Diagnostic imaging of child abuse, 2nd edn. Mosby, St LouisGoogle Scholar
  22. 22.
    Chazal J, Irthum B, Janny P (1989) Ventricular subarachnoidal hydrocephalus of arachnoid villi origin. Neurochirurgie 35(6):379–382PubMedGoogle Scholar
  23. 23.
    Robertson WC Jr, Chun RW, Orrison WW, Sackett JF (1979) Benign subdural collections of infancy. J Pediatr 94(3):382–386, MarPubMedCrossRefGoogle Scholar
  24. 24.
    Papasian NC, Frim DM (2000) A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma. Pediatr Neurosurg 33(4):188–193, OctPubMedCrossRefGoogle Scholar
  25. 25.
    Baker AB (1938) Subdural hematoma. Arch Pathol Lab Med 26:535–559Google Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Jean-Sébastien Raul
    • 1
    • 2
  • Sébastien Roth
    • 1
  • Bertrand Ludes
    • 2
  • Rémy Willinger
    • 1
  1. 1.Institut de Mécanique des Fluides et des SolidesUMR 7507 ULP CNRSStrasbourgFrance
  2. 2.Institut de Médecine LégaleStrasbourgFrance

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