Test 10

Abstract

CT of the head showed subdural haemorrhage in the posterior fossa and the right side of the falx; no other brain injury or acute intracranial haemorrhage was demonstrated. Subdural haemorrhages can be found in neonates on imaging following delivery, both normal vaginal and assisted (forceps/ventouse) but are usually ‘clinically silent’ and when present in asymptomatic infants are usually infratentorial in location and usually resolve by 4 weeks following delivery. This is contrasted with the pattern of subdural haemorrhage found in inflicted injury which is typically supratentorial—bilateral or interhemispheric. The infratentorial haemorrhage in this child had resolved on the MRI performed 2 days later and imaging of the spine was normal. It is imperative that cross-sectional imaging of the neuroaxis (i.e. of the brain and spine) is performed in the imaging investigation of suspected physical abuse, as recommended in the national guidance. Investigation with initial and follow-up skeletal survey did not reveal any other acute or healing fractures. It was felt that this fracture, whilst unexplained, alongside the pattern of intracranial haemorrhage, was probably sustained at the time of delivery.