The volume of the SDH varied from 0. A crescentic subdural haematoma over the left fronto-parieto-temporal region with a contralateral midline shift. Distribution of cases according to the post-traumatic interval and mean attenuation of subdural haemorrhage. The intra-class correlation coefficient for intra-reader reliability of the first and second readers were 0. The prediction of PTI was based on density and volume.
In logistic regression, after applying forward likelihood ratio method, only density was found out to be significant and is used in the model to predict PTI. The timing of a traumatic event by post-mortem findings carries immense significance for the forensic experts.
Age determination of subdural hematomas with CT and MRI: a systematic review.
Multiple methods to determine the age of injury are available which include but not limited to the healing of abrasions, contusions, and other injuries. The aim of the present study was to determine the post-traumatic interval of the early subdural haematomas based on computed tomography attenuation numbers. In this study, crescent shaped haemorrhages were distinctively selected to determine the effect of blood volume on attenuation. The variation in density pattern is observed on computed tomography about extravasation of blood with time [ 14 — 16 ].
An acute subdural haemorrhage has a computed tomographic attenuation value that is dependent largely on the proportions of red blood cells, haemoglobin and iron content, and fibrin. An acute thrombus is formed from fibrin, platelets, neutrophils, and red blood cells, and as the cells start losing its integrity, swelling often occurs [ 17 ]. Attenuation also depends on beam energy and may, therefore, differ significantly between different CT scanners. Earlier studies have reported Scanner-dependent variability in CT numbers [ 19 , 22 , 23 ].
However, in Strandberg et al. This contention was avoided in our study by the utilization of a single CT machine with a single standard specification for all the cases. Few studies have been attempted long back for dating the subdural haemorrhage using computed tomography. All the above studies have tried to classify subdural haemorrhage into acute, subacute or chronic depending on the attenuation.
The present study, unlike others, included only early cases of SDH and further differentiation of the haemorrhage according to age was attempted within this short post-traumatic interval. It is pertinent to note that these studies also do not mention the specific radiological methods applied in estimating the age of the subdural haematoma. After about days of the clot formation, the density drops to about 30HU and becomes isodense with the adjacent cortex [ 4 ].
Since the cases in the present study were well within or close to 10 days, all the cases had a high attenuation, which is in concordance with all the above published data. Correlation of attenuation of the haematoma and time interval between injury and computed tomography was found to be highly negative i. The determination of the post-traumatic interval of the subdural haemorrhage is a complex problem and has been worked out by a very few investigators. Hence a very limited number of studies with which the results of the present study could be compared.
These findings accord with the results of other studies examining Intra-reader reliability of attenuation measurements [ 19 ]. Currently, the dating of subdural haemorrhage by measuring the CT number alone could lead to inaccuracies as it depends on measurement technique, object composition, and beam energy. Therefore with further research on this subject, the attenuation of subdural haemorrhages can be measured with more reliability and, thereby placing them accurately into particular post-traumatic interval groups. However, the outcome of living patients may not be entirely transferable to post-mortem radiology.
The application of the current methodology to post-mortem cases will be an oversimplification. Though, the few post-mortem radiological studies conducted previously have inferred minimal difference with the autopsy findings in cases of craniocerebral trauma, not much work has been done on decomposed bodies [ 23 , 24 ]. Further in these studies [ 23 , 24 ], the cases had a time interval of less than 24hours between the death and postmortem radiological examination. These studies concentrated mainly on the gross features rather than going into specifics like aging and the degree of the autolytic process if any.
From the radiological point of view, the dating of early SDH remains limited, in the fact that all the SDH were hyper dense, but concurs with the already published data [ 4 , 25 , 26 ]. However, on a further classification of these HU numbers about post-traumatic intervals, information was obtained on the range of attenuation for a particular post-traumatic interval. Though few studies suggest that dating of subdural haematoma cannot be done accurately using radiological methods [ 25 — 27 ], the present study, yet gives a reliable and a reproducible method for the estimation of the age of early subdural haemorrhage.
Not many studies have been conducted recently on the radiological dating of SDH. Those studies which have dealt with the radiological dating of SDH have not specified the radiological methods and hence the comparison with different studies have been limited. The results from one of the recently conducted questionnaire based study showed that there was a considerable variation among the radiologists, regarding medico-legal opinions on the age of SDH and concluded it unsuitable to use in court because of non-uniformity [ 28 ].
The study was limited by the small sample of materials investigated. The influence of hypothermia, shock, hypoxia, variations in the blood pressure, the effect of medications during emergency care, potential effects of associated injuries and failure of the internal organs were not evaluated. Repeat CT examinations of the same patient at various times were not done in our study.
Also, a single CT scan machine was used in this study hence variations in attenuation between different CT Scanners could not be appreciated. Because of the difficulty in differentiation into antemortem and postmortem breakdown of cellular components, it is hard to predict the post-traumatic intervals in decomposing bodies. Finally, the CT Scanner and protocol that have been used in this study is not the state of the art concerning its various parameters.
Though single slice CT scanners are not used in state of the art head scans [ 29 ], the constraints on the availability of advanced scanners in a developing country like India, has compelled us to use the resources at hand. Considering a few recent studies being done on the postmortem use of the radiological technologies in the interpretation of the cranio-cerebral traumatic injuries [ 23 , 24 ] one can with some confidence say that these methods hold a lot of stake for the future of radiological autopsy or may indeed replace few of the routinely conducted forensic autopsies of the present times.
The present study has adopted one of the most objective and scientific methods in determining the attenuation of the subdural haematomas in contrast to the other previous studies where none has been applied or has not been mentioned. Though this study has been limited to the early post-traumatic intervals, it could still grasp some significant findings in the form of variations in the attenuation of the subdural haemorrhage with relation to time of the injury.
The attenuation of the acute subdural haemorrhage decreased with increase in the post-traumatic interval.
Subdural hemorrhage | Radiology Reference Article | tyweseryco.tk
On further classification of these HU numbers about post-traumatic intervals, information was obtained on the range of attenuation for a particular post-traumatic interval. The variations in the hospital care and treatment, the mode of injuries high velocity , have considerably changed over the years and hence could have contributed to the observed variations despite proper study design.
These are also in part due to the dynamic character of such injuries and the various manner in which trauma victims react to an injury. Imaging of nonaccidental head injury. Evidence-Based Imaging in Pediatrics ; Neuroimaging of nonaccidental head trauma; pitfalls and controversies.
Subdural Hemorrhage in Abusive Head Trauma: Imaging Challenges and Controversies
Pediatric Radiol ; Barnes P, Krasnokutsky M. Top Magn Reson Imaging ; Wang CT, Holton J.
Total estimated cost of child abuse neglect in the United States. Prevent Child Abuse America Web site. Subdural hematoma and non-accidental head injury in children.
Assessment of the nature and age of subdural collections in nonaccidental head injury with CT and MRI. Pediatric Radiol, ; Eur Radiol, ; MR characteristics of subdural hematomas and hygromas at 1. The computed tomographic attenuation and the age of subdural hematomas. J Korean Med Sci ; Imaging of head injuries in infants: J Neurosurg Pediatrics 1 ; CT mimic of recurrent episodes of bleeding in the setting of child abuse. Magnetic resonance in imaging of chronic subdural hematoma. Neurosurg Clin N Am. Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography.
Comparison of intracranial computed tomographic findings in pediatric abusive and accidental head trauma. Pediatr Rad ; Munro D, Merritt H. Surgical pathology of subdural hematoma. Based on a study of cases. The aetiology of subdural hematoma: J Nerv Ment Dis. Intacranial hemorrhage and rebleeding in suspected victims of abusive head trauma: Child Maltreat ; 7: Intracranial hemorrhage in term with newborns: Pediatr Neurol ; Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. Sonographic findings in infants with macrocrania. CT and MR in infants with pericerebral collections and macrocephaly: Benign enlargement of the subarachnoid spaces versus subdural collections.
Subdural hygroma versus atrophy on MR brain scans: Subdural hematoma in infants: Data from a prospective series and critical view of the literature. Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. Ravid S, Maytal J. Influence of the benign enlargement of the subarachnoid space on the bridging veins strain during a shaking event: Int J Legal Med. Spektor Amodio, Pramanik B et al. Articles Cases Courses Quiz. About Blog Go ad-free. Subdural hemorrhage Dr Karwan T. Cases and figures Imaging differential diagnosis.
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Read it at Google Books - Find it at Amazon. Edit article Share article View revision history. Central Nervous System , Trauma. Synonyms or Alternate Spellings: Support Radiopaedia and see fewer ads. SDH with acute, intermediate and old blood Case SDH with acute, intermediate and old blood. Case 17 Case SDH resulting in marked mass effect Case SDH resulting in marked mass effect.
SDH with fluid-fluid levels Case SDH with fluid-fluid levels. Illustration - extradural haemorrage Illustration - extradural haemorrage. Motion artefact Motion artefact. Extradural hematoma Extradural hematoma.
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