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Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse.
[child syndrome]
Patients
who
have
benign
enlargement
of
the
subarachnoid
spaces
(
BESS
)
have
long
been
suspected
of
having
an
increased
propensity
for
subdural
hematomas
either
spontaneously
or
as
a
result
of
accidental
injury
.
Subdural
hematomas
in
infants
are
often
equated
with
nonaccidental
trauma
(
NAT
)
.
A
better
understanding
of
the
clinical
and
imaging
characteristics
of
subdural
hematomas
that
occur
either
spontaneously
or
as
a
result
of
accidental
trauma
may
help
distinguish
this
group
of
patients
from
those
who
suffer
subdural
hematomas
as
a
result
of
NAT
.
The
purpose
of
this
study
is
to
describe
the
clinical
and
imaging
characteristics
of
subdural
hematomas
that
occur
either
spontaneously
or
as
a
result
of
accidental
injury
in
infants
with
BESS
.
We
conducted
a
retrospective
review
of
all
patients
with
BESS
complicated
by
subdural
hematomas
evaluated
at
a
single
institution
from
1998
to
2004
.
Data
concerning
the
patient
's
clinical
presentation
,
physical
findings
,
imaging
,
and
management
are
described
.
During
the
study
period
,
7
patients
with
BESS
complicated
by
subdural
hematoma
were
identified
.
Their
mean
age
at
identification
of
the
subdural
hematoma
was
7
.
4
months
of
age
.
In
5
cases
,
there
was
no
recognized
trauma
before
identification
of
the
subdural
hematoma
.
In
3
cases
,
baseline
CT
or
MR
imaging
was
available
,
showing
prominent
subarachnoid
spaces
without
any
evidence
of
subdural
hemorrhage
.
Although
suspicious
for
NAT
,
subdural
hematomas
can
occur
in
children
either
spontaneously
or
as
a
result
of
accidental
trauma
.
Caution
must
be
exercised
when
investigating
for
NAT
based
on
the
sole
presence
of
subdural
hematomas
,
especially
in
children
who
are
otherwise
well
and
who
have
BESS
.
Diseases
Validation
Diseases presenting
"recognized trauma before identification of the subdural hematoma"
symptom
child syndrome
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