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An infant with subdural hematoma and retinal hemorrhages: does von Willebrand disease explain the findings?

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Abstract

An 11-month-old girl presented to hospital with a massive subdural haematoma and bilateral retinal haemorrhages following an allegedly minor fall. There were no external signs of bruising and no prior bleeding tendency was reported. Although initial analyses were normal, repeated testing of the coagulation-fibrinolysis system led to a diagnosis of mild von Willebrand disease (vWD) Type 1. It was concluded that minor head trauma as described by the parents, in the presence of such a coagulation disorder, could explain the findings. Police charges against the parents, initially accused of child abuse, were withdrawn. Retinal haemorrhages in infants with vWD have not been previously reported. This case highlights the importance of considering vWD as a possible contributory factor in cases of infant head injury.

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References

  1. Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Arch Pediatr Adolesc Med. 2000;154:11–5.

    CAS  PubMed  Google Scholar 

  2. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants—the “shaken-baby syndrome”. N Engl J Med. 1998;338:1822–9.

    Article  CAS  PubMed  Google Scholar 

  3. Harding B, Risdon RA, Krous HF. Shaken baby syndrome. BMJ. 2004;328:720–1.

    Article  PubMed  Google Scholar 

  4. Case ME, Graham MA, Handy TC, Jentzen JM, Monteleone JA. Position paper on fatal abusive head injuries in infants and young children. Am J Forensic Med Pathol. 2001;22:112–22.

    Article  CAS  PubMed  Google Scholar 

  5. Lyons TJ, Oates RK. Falling out of bed: a relatively benign occurrence. Pediatrics. 1993;92:125–7.

    CAS  PubMed  Google Scholar 

  6. Chadwick DL, Bertocci G, Castillo E, Frasier L, Guenther E, Hansen K, Herman B, Krous HF. Annual risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics. 2008;121:1213–24.

    Article  PubMed  Google Scholar 

  7. Hymel KP, Jenny C, Block RW. Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: addressing the forensic controversies. Child Maltreat. 2002;7:329–48.

    Article  PubMed  Google Scholar 

  8. Michiels JJ, Berneman Z, Gadisseur A, van der PM, Schroyens W, van Vliet HH. Laboratory diagnosis and molecular basis of mild von Willebrand disease type 1. Acta Haematol. 2009;121:85–97.

    Article  CAS  PubMed  Google Scholar 

  9. Ragni MV, Bontempo FA, Hassett AC. von Willebrand disease and bleeding in women. Haemophilia. 1999;5:313–7.

    Article  CAS  PubMed  Google Scholar 

  10. Ziv O, Ragni MV. Bleeding manifestations in males with von Willebrand disease. Haemophilia. 2004;10:162–8.

    Article  CAS  PubMed  Google Scholar 

  11. Ling R, James B. White-centred retinal haemorrhages (Roth spots). Postgrad Med J. 1998;74:581–2.

    Article  CAS  PubMed  Google Scholar 

  12. Kivlin JD, Simons KB, Lazoritz S, Ruttum MS. Shaken baby syndrome. Ophthalmology. 2000;107:1246–54.

    Article  CAS  PubMed  Google Scholar 

  13. Oehmichen M, Schleiss D, Pedal I, Saternus KS, Gerling I, Meissner C. Shaken baby syndrome: re-examination of diffuse axonal injury as cause of death. Acta Neuropathol. 2008;116:317–29.

    Article  PubMed  Google Scholar 

  14. Hymel KP, Makoroff KL, Laskey AL, Conaway MR, Blackman JA. Mechanisms, clinical presentations, injuries, and outcomes from inflicted versus noninflicted head trauma during infancy: results of a prospective, multicentered, comparative study. Pediatrics. 2007;119:922–9.

    Article  PubMed  Google Scholar 

  15. Binenbaum G, Mirza-George N, Christian CW, Forbes BJ. Odds of abuse associated with retinal hemorrhages in children suspected of child abuse. J AAPOS. 2009;13:268–72.

    Article  PubMed  Google Scholar 

  16. Ganesh A, Stephens D, Kivlin JD, Levin AV. Retinal and subdural haemorrhages from minor falls? Br J Ophthalmol. 2007;91:396–7.

    Article  PubMed  Google Scholar 

  17. Van Ee C, Raymond D, Thibault K, Hardy B, Plunkett, J. Child ATD reconstruction of a fatal pediatric fall. November 13–19, 2009 Lake Buena Vista, Florida, USA. In: Proceedings of the ASME 2009 international mechanical engineering congress & exposition, IMECE, Paper no IMECE2009-12994. 2009.

  18. Kivlin JD, Currie ML, Greenbaum VJ, Simons KB, Jentzen J. Retinal hemorrhages in children following fatal motor vehicle crashes: a case series. Arch Ophthalmol. 2008;126:800–4.

    Article  PubMed  Google Scholar 

  19. Mills MD. Terson syndrome. Ophthalmology. 1998;105:2161–3.

    Article  CAS  PubMed  Google Scholar 

  20. Whitby EH, Griffiths PD, Rutter S, Smith MF, Sprigg A, Ohadike P, Davies NP, Rigby AS, Paley MN. Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet. 2004;363:846–51.

    Article  CAS  PubMed  Google Scholar 

  21. Hughes LA, May K, Talbot JF, Parsons MA. Incidence, distribution, and duration of birth-related retinal hemorrhages: a prospective study. J AAPOS. 2006;10:102–6.

    Article  PubMed  Google Scholar 

  22. Vinchon M, Noule N, Tchofo PJ, Soto-Ares G, Fourier C, Dhellemmes P. Imaging of head injuries in infants: temporal correlates and forensic implications for the diagnosis of child abuse. J Neurosurg. 2004;101:44–52.

    PubMed  Google Scholar 

  23. Tung GA, Kumar M, Richardson RC, Jenny C, Brown WD. Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics. 2006;118:626–33.

    Article  PubMed  Google Scholar 

  24. McNeely PD, Atkinson JD, Saigal G, O’Gorman AM, Farmer JP. Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. AJNR Am J Neuroradiol. 2006;27:1725–8.

    CAS  PubMed  Google Scholar 

  25. Papasian NC, Frim DM. A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma. Pediatr Neurosurg. 2000;33:188–93.

    Article  CAS  PubMed  Google Scholar 

  26. Squier W, Mack J. The neuropathology of infant subdural haemorrhage. Forensic Sci Int. 2009;187:6–13.

    Article  PubMed  Google Scholar 

  27. Herrmann WA, Lohmann CP, Mmler-Hackenberg M, Gabel VP. Von Willebrand’s disease type I as a cause for subvitreal, retinal and subretinal haemorrhages. Graefes Arch Clin Exp Ophthalmol. 2005;243:383–5.

    Article  PubMed  Google Scholar 

  28. Shiono T, Abe S, Watabe T, Noro M, Tamai M, Akutsu Y, Ishikawa M, Suzuki S, Mori K. Vitreous, retinal and subretinal hemorrhages associated with von Willebrand’s syndrome. Graefes Arch Clin Exp Ophthalmol. 1992;230:496–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pathology, Oslo University Hospital and Institute of Forensic Medicine, University of Oslo, Rikshospitalet, 0027, Oslo, Norway

    Arne Stray-Pedersen

  2. Department of Ophtalmology, Oslo University Hospital, 0027, Oslo, Norway

    Sigrid Omland

  3. Department of Radiology, Oslo University Hospital, 0027, Oslo, Norway

    Bård Nedregaard

  4. Paediatric Clinic, Buskerud Hospital, 3004, Drammen, Norway

    Sjur Klevberg

  5. Institute of Forensic Medicine, University of Oslo, 0027, Oslo, Norway

    Torleiv Ole Rognum

Authors
  1. Arne Stray-Pedersen
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  2. Sigrid Omland
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  3. Bård Nedregaard
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  4. Sjur Klevberg
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  5. Torleiv Ole Rognum
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Correspondence to Arne Stray-Pedersen.

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Stray-Pedersen, A., Omland, S., Nedregaard, B. et al. An infant with subdural hematoma and retinal hemorrhages: does von Willebrand disease explain the findings?. Forensic Sci Med Pathol 7, 37–41 (2011). https://doi.org/10.1007/s12024-010-9176-7

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  • DOI: https://doi.org/10.1007/s12024-010-9176-7

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