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Hemophilia and non-accidental head trauma in two siblings: lessons and legal implications

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Abstract

Non-accidental head trauma (NAHT) is a common cause of traumatic brain injury in childhood, origin of profound and disabling neurological sequalae, and in the most disgraceful cases, ultimately death.

Subdural hematoma (SDH) is the most common intracranial finding in NAHT. On the other hand, congenital bleeding disorders are a minor but a significant cause of ICH in the neonate and toddler. Not uncommonly, intracranial bleeding is the first sign of a severe inherited coagulation disorder. In the presence of an unexpected intracranial bleeding after a minor trauma or without a clear history of the related events, physicians and caregivers may be confronted to the dilemma of a possible child abuse. It must be bear in mind that physical abuse and bleeding disorders can co-exist in the same child.

We report here the case of two siblings in whom a diagnosis of hemophilia coexisted with the presumption of a non-accidental head trauma. Child abuses were inflicted in both children with a spare time of 2 years. A diagnosis of mild hemophilia was prompted in the first sibling after initial NAHT, while inflicted trauma was evident in the second sibling after neuroimaging findings and concomitant lesions. Lessons from this case in co-existing bleeding disorders and inflicted trauma and legal implications derived will be discussed thereafter.

The possibility of a bleeding disorder should be considered in all children presenting with unexplained bleeding at a critical site in the setting of suspected physical maltreatment, particularly intracranial hemorrhage (ICH).

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All data (anonymized) including laboratory tests and images are fully available under request.

Abbreviations

NAHT :

Non-accidental head trauma

TBI :

Traumatic brain injury

ICH :

Intracranial hemorrhage

IBD :

Inherited bleeding disorders

SDH :

Subdural hemorrhage(s)

BESS :

Benign enlargement of subarachnoid spaces

vWF :

Von Willebrand factor

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Author notes

  1. Hinojosa J., Simó M., Berrueco R., and Armero G. contributed equally to the authorship of this paper.

Authors and Affiliations

  1. Department of Neurosurgery, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain

    J. Hinojosa, G. Armero, M. V. Becerra, M. Alamar, S. Candela & D. Culebras

  2. Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona, Spain

    M. Simó & G. Armero

  3. Department of Radiology, Hospital Sant Joan de Déu, Barcelona, Spain

    J. Muchart

  4. Department of Pediatric Hematology, Hospital Sant Joan de Déu, Barcelona, Spain

    R. Berrueco

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  1. J. Hinojosa
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Contributions

Dr. José Hinojosa, Dra. Marta Simó, Dr. Rubén Berrueco, and Dra. Georgina Armero contributed equally to the authorship of this paper. Dra. Marta Simó and Dr. Rubén Berrueco provided the idea (selection of the case) for this paper. Dr. Maria Victoria Becerra, Dr. Mariana Alamar, Dr. Santiago Candela, Dr. Jordi Muchart, and Dr. Diego Culebras critically reviewed the manuscript. Dr. Jordi Muchart provided differential diagnosis and prepared the images for publication.

Corresponding author

Correspondence to J. Hinojosa.

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Hinojosa, J., Simó, M., Armero, G. et al. Hemophilia and non-accidental head trauma in two siblings: lessons and legal implications. Childs Nerv Syst 38, 2415–2423 (2022). https://doi.org/10.1007/s00381-022-05713-2

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