Abusive head trauma: Extra-axial hemorrhage and nonhemorrhagic collections

This chapter, written by a team of radiologists, a pathologist and a child abuse pediatrician, focuses on extra-axial hemorrhage, i.e., epidural, subdural, subarachnoid and intraventricular hemorrhage, in relation to abusive head trauma. For each, an in-depth discussion of the hemorrhage and it’s clinical presentation in combination with imaging and neuropathological considerations is presented. In the section on subdural hematomas (SDHs), attention is also focused on birth-related SDHs and SDHs in children with benign enlargement of the subarachnoid space. Other types of subdural collections are presented, although with a more limited scope. Given the relevance in child abuse investigations the authors also present data helpful in differentiating between accidental and nonaccidental causes of extra-axial hemorrhage and on the potential of imaging and neuropathologic examinations in dating the traumatic event leading to the extra-axial hemorrhage.