The Big Black Brain: Subdural Hemorrhage with Hemispheric Swelling and Low Attenuation
The term “Big Black Brain” was first coined in 1993 to describe cases of abusive head trauma associated with subdural hematoma(s), brain swelling, and uni- or bilateral hypo-density involving the entire supratentorial compartment on CT scan imaging. This constellation of findings was invariably followed by extensive cerebral parenchymal destruction and a dismal neurological outcome or death. We describe two such cases and review the pathophysiology and differential diagnosis of this entity.
KeywordsBig black brain Abusive head trauma Cerebral edema Cerebral hypodensity Subdural hematoma Brain damage
The authors would like to thank Kara G. Gill, MD for contributing radiologic imaging to this manuscript.
Compliance with ethical standards
Disclosure of Interest
Drs. Knox and Feldman both testify in civil and criminal trials. Monies earned are given to their respective institutions and to Dr. Feldman. Drs. Knox and Luyet are currently authoring a book on child torture as a form of child abuse.
Ethical Standards and Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation [institutional and national] and with the Helsinki Declaration of 1975, as revised in 2000. This manuscript discusses two cases of children with big black brain presentations. Both the University of Wisconsin Health Sciences IRB and the University of Washington IRB did not require IRB approval for these case reports. Additionally, no informed consent of patients was required.
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