This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection. The forces required to cause brain injury were derived from an experiment of high velocity impacts on monkeys, that generated forces far above those which might occur with a shaking mechanism. These forces, if present, would invariably cause neck trauma, which is conspicuously absent in most babies allegedly injured by shaking. Subdural hematoma may also be the result of common birth trauma, complicated by prenatal vitamin D deficiency, which also contributes to the appearance of long bone fractures commonly associated with child abuse. Retinal hemorrhage is a non-specific finding that occurs with many causes of increased intracranial pressure, including infection and hypoxic brain injury. The evidence challenging these connections should prompt emergency physicians and others who care for children to consider a broad differential diagnosis before settling on occult shaking as the de-facto cause. While childhood non-accidental trauma is certainly a serious problem, the wide exposure of this information may have the potential to exonerate some innocent care-givers who have been convicted, or may be accused, of child abuse.
Doctor Sued Over Late Diagnosis of Subdural Hematoma
If symptoms are maximal at onset, the cause is more likely to be a subarachnoid hemorrhage or an embolic stroke. Causes Thrombotic stroke Illustration of an embolic stroke, showing a blockage lodged in a blood vessel. In thrombotic stroke, a thrombus  blood clot usually forms around atherosclerotic plaques. Since blockage of the artery is gradual, onset of symptomatic thrombotic strokes is slower than that of a hemorrhagic stroke.
The word “crazy” means different things to different people. A cat lady is crazy. That homeless guy on the street is crazy. Your ex girlfriend is crazy (or at least she has a personality disorder).. However, there is a much more interesting, much more dangerous form of crazy – psychosis.
Hearing loss or hearing ringing tinnitus Blurred Vision Causes[ edit ] Subdural hematomas are most often caused by head injury , when rapidly changing velocities within the skull may stretch and tear small bridging veins. Subdural hematomas due to head injury are described as traumatic. Much more common than epidural hemorrhages , subdural hemorrhages generally result from shearing injuries due to various rotational or linear forces. Subdural hematoma is also commonly seen in the elderly and in alcoholics, who have evidence of cerebral atrophy.
Cerebral atrophy increases the length the bridging veins have to traverse between the two meningeal layers, hence increasing the likelihood of shearing forces causing a tear. It is also more common in patients on anticoagulants or antiplatelet drugs , such as warfarin and aspirin. Patients on these medications can have a subdural hematoma after a relatively minor traumatic event.
A further cause can be a reduction in cerebral spinal fluid pressure which can create a low pressure in the subarachnoid space, pulling the arachnoid away from the dura mater and leading to a rupture of the blood vessels.
Subdural Hemorrhage in Abusive Head Trauma: Imaging Challenges and Controversies
Download powerpoint Fig 5. Axial NCCT demonstrates large bilateral subdural collections hyperattenuating to CSF white arrows and a hyperattenuating subdural compartment neomembrane black arrow. On T2WI, the subdural fluid is isointense to CSF white arrows and nicely demonstrates multiple neomembranes black arrows. Four cases demonstrated subdural compartment neomembranes, with very subtle or absent hemosiderin staining along the neomembranes in 2 cases.
A subdural hematoma (SDH), is a type of hematoma, usually associated with traumatic brain injury. Blood gathers between the inner layer of the dura mater and the arachnoid mater. Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue.
Physicians have an ethical and legal mandate to identify abused children so that they may be protected from further harm and are simultaneously required to think broadly and objectively about differential diagnoses. The medical literature is replete with examples of medical diseases that mimic abuse, potentially leading to misdiagnoses and subsequent harm to children and families. This review highlights some of the common and uncommon diseases that mimic physical and sexual abuse of children.
Christian provides medical-legal expert work in child abuse cases. Published January 25, Accessed January 13, 2. The effects of childhood stress on health across the lifespan. Burden and consequences of child maltreatment in high-income countries. The mistaken diagnosis of child abuse: Mil Med ; Cutaneous findings mistaken for physical abuse: Pediatr Dermatol ; Non-cutaneous conditions clinicians might mistake for abuse.
Neurologic and Mental
Facts about the brain: The brain contains around billion neurons. We have all our neurons when we are babies, but they aren’t yet connected as in an adult. Further, the brain is not fully myelinated until age years. This probably explains most developmental milestones, including those of Piaget.
Shaken Baby Syndrome (SBS), also known as abusive head trauma or non-accidental injury, as an unscientific medical misdiagnosis, or medical myth, falsely-accused of SBS, wrongfully convicted of child abuse, alternative causes.
Yet that was not enough for you to order a CT scan? Because she had it several times before and in previous admissions as well. Based on your question overruled. In Vazirzadeh, the issue was whether the defendant doctor failed to diagnose and treat the decedent’s symptoms of a pulmonary embolism. The decedent’s symptoms, including shortness of breath and chest pain, were not disputed. The defendant doctor, while testifying as an adverse witness in the plaintiff’s case, testified, in response to questions from his own attorney, that the decedent told him that his chest pain was of short duration, was relieved by belching, and was not significant.
On appeal, this court held that the testimony was barred by the Act, as the plaintiff had not questioned the defendant about that conversation between the doctor and the decedent. Theofanis also involved the situation where the defendant doctor was cross-examined by his own attorney after being called as an adverse witness in the plaintiff’s case.
There, the defendant doctor sought to testify to a conversation with the decedent about which the plaintiff’s attorney had not asked. In this case, unlike in Vazirzadeh or Theofanis, the complained-of testimony was elicited by the plaintiff’s own attorney during an adverse examination. One of the objectives of the Act is fundamental fairness.
Abusive head trauma: extra-axial hemorrhage and nonhemic collections
Since Caffey first described a series of children with chronic subdural hematomas and multiple long bone fractures, radiologists have played an important role, along with pediatricians and pathologists, in evaluating abused children. Each has distinct clinical applications, as well as practical uses in the clinical diagnostic process of AHT. Importantly, neuroimaging assists in the process of differential diagnosis of other conditions which may mimic AHT. Collaboration between neuroradiologists, clinicians, and pathologists remains critical to making the appropriate diagnosis.
Cyberfriends: The help you’re looking for is probably here. This website collects no information. If you e-mail me, neither your e-mail address nor any other information will ever be passed on to any third party, unless required by law.
The estimation of time since injury in cases of subdural haemorrhage has been studied only by a few investigators on the histological and radiological front. Materials and Methods The study included a total of cases of closed head injury with subdural haemorrhage. Results Statistically significant results were obtained between the HU measurements of the SDH and the post-traumatic intervals and were found to be statistically significant. A rough attempt was made to determine the effect of haematoma volume on attenuation and was found out to be statistically insignificant.
Conclusion The density of the subdural haematoma decreases with increase in the post-traumatic interval that concurs with the limited number of studies being conducted in the past. We concluded that further sorting of cases could be done according to its age with additional research and uniformity in the methodology. Attenuation coefficient, Computed tomography, Post-traumatic interval, Subdural haemorrhage, Volume Introduction Subdural Haemorrhage SDH is a form of brain haemorrhage in which there is a collection of blood between the dura and the arachnoid layers of the meninges.
Age determination of subdural hematomas with CT and MRI: a systematic review.
It is important to note that in the cases of accidental head injury that were accompanied by retinal hemorrhages, there was a clear history of head trauma that was given by the caregivers when the child first presented for care. It is also noteworthy that the types of retinal hemorrhages present in children with accidental head injury were distinctly different from those present in children with abusive head injury in that they were confined to the intraretinal layer, did not cover the macula, and did not extend to the periphery of the retina.
Other studies have stated there is no clinical difference to differentiate between them.
A seizure, technically known as an epileptic seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness (tonic-clonic seizure), to shaking movements involving only part of the body with variable levels of consciousness (focal seizure.
I have an anxiety disorder on and off. This raises my BP readings. The risk here is sudden incapacitation. Still is a disqualifier. Does vertigo disqualify me from getting a medical card? When the medical examiner does his examination, one of the things he is looking for is things that would be unsafe for you as a driver and how it effects your ability to maintain control of a commercial motor vehicle.
Part of that examination is to test for virtigo. If he feels the condition is unsafe then he will not pass you. If he feels there is something that can help you maintain, he may make a suggestion for you to follow-up with a specialist. Drivers who have had one unprovoked seizure by definition do not have epilepsy 2 or more unprovoked seizures. Drivers who are seizure-free and off anticonvulsant medication s for at least 5 years after a single unprovoked seizure can be certified.
Earlier return to work may be considered for drivers with a normal EEG who have no epileptic-form activity and normal examination by a neurologist specializing in epilepsy.
Chronic subdural hematomas: a review
Lumpy Like any combination of these characteristics When you push on a hematoma, it may move around under the skin, feeling uncomfortable or even painful. Though these signs and symptoms may be disconcerting, they are not usually a cause for alarm. Usually, the body will eventually reabsorb the blood that formed the hematoma without any need for treatment. Treatment for Bruising Bruises will generally heal on their own, but treatment may help a hematoma heal faster and in some cases, offer relief from any pain or discomfort.
There are many ways to treat this issue , including:
Immunity tends to wane by 20 percent a month, leaving those who got their shot in August or September with less than desirable protection by the time they’re exposed.
Uscinski described an experiment set up by A. Ommaya who “devised an experiment to measure more precisely the amount of rotational acceleration necessary to reach the threshold of injury. A contoured fiberglass chair was built, mounted on wheels, and placed on tracks with a piston behind it. Rhesus monkeys were strapped into the chair with their heads free to rotate. The piston then impacted the chair, simulating a rear-end motor vehicle collision.
Ommaya was able to produce intracranial injury in 19 of the animals, with 11 of them also demonstrating neck injury. At that time it was shown quantitatively that impact was required to generate adequate force. Yet no laboratory proof of this possibility has ever been put forth. In fact, the available experimental evidence, beginning as far back as , addressed directly in and reproduced in , seems to indicate the contrary.