The Role of the Iron Stain in Assessing Intracranial Hemorrhage

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Subdural hematoma

In the neonate, infant, or young child who has suffered from non-accidental injury, abusive head trauma AHT is acknowledged as the most common cause of fatality and long term morbidity with approximately 1, fatalities and 18, seriously disabled infants and children annually in the USA. Beyond the tragedy of an injured or murdered child is the broader social and community impact of this national and international health blight.

In addition to the emotional, family, and social costs caused by inflicted trauma, the societal financial burden is astounding.

As far as Magnetic Resonance Imaging (MRI) is considered, it is more sensitive than CT in the detection of SDH because of its multi-planarity and.

Caffey described the effects of shaking on infants, and its association with bilateral retinal hemorrhage and the typical metaphyseal corner fracture 7. His theory of whiplash-shaking was supported by the finding of bilateral subdural hemorrhage, and the frequent absence of evidence of impact injury. It is true that while it is unusual to slap or spank an infant, the significance of shaking or jerking has only been realized in recent times.

Shaking produces repeated acceleration— deceleration forces, so-called whiplash, mainly in an antero-posterior direction, but the brain will also rotate within the calvarium, as a secondary motion. These movements can cause tearing of the delicate bridging veins, which course from the cerebral cortex, through the subarachnoid space and the potential subdural space, to drain into the venous sinuses.

This results in hemorrhage into the subarachnoid or subdural spaces Fig. The infant brain is more at risk from a shaking injury due to its greater relative weight, the lack of tone in the supporting muscles of the neck, and the poor myelination associated with a higher water content. The relative degree of myelination contributes to the development of shearing injuries, most commonly at the gray—white interface, with a subcortical or callosal location. This may be a reflection of the different densities of gray and white matter.

There is often controversy as to the precise mechanism of injury, whether it be a pure shaking-whiplash injury, or whether there is an additional impact injury. The forces generated with an impact are of an order of magnitude greater than with shaking 9. Impact against a soft surface, such as a mattress or sofa, does not significantly reduce the effect of the impact, but it does dissipate the trauma.

Therefore the resulting signs of external injury are few, and there is no evidence of a focal impact type cerebral injury.

Chapter Contents

Types of intracranial hemorrhage Optimal imaging procedure for investigation of intracranial hemorrhage Etiology for intracranial hemorrhage Imaging findings of each type of intracranial hemorrhage Systematic reading of imaging study in suspected case of intracranial hemorrhage What are the types of presentation of intracranial hemorrhage? Subdural hematoma Epidural hematoma Subarachnoid hemorrhage Intracerebral hemorrhage Intraventricular hemorrhage Hemorrhage in different anatomical sites has various etiologies.

Pre-contrast CT scan is the imaging procedure of choice to evaluate intracerebral hemorrhage.

magnetic resonance imaging in Shaken Baby Subdural haematoma and non-​accidental head injury in Salmon C. Dating the abusive head trauma episode.

A chronic subdural hematoma is an “old” collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura. The chronic phase of a subdural hematoma begins several weeks after the first bleeding. A subdural hematoma develops when bridging veins tear and leak blood. These are the tiny veins that run between the dura and surface of the brain.

This is usually the result of a head injury. A collection of blood then forms over the surface of the brain. In a chronic subdural collection, blood leaks from the veins slowly over time, or a fast hemorrhage is left to clear up on its own. A subdural hematoma is more common in older adults because of normal brain shrinkage that occurs with aging.

Age determination of subdural hematomas with CT and MRI: a systematic review.

When evaluating prominent extracerebral mri and considering the diagnosis hemorrhage benign subarachnoid fluid, the radiologist should look for clues that trauma assignment of the of the fluid to the subarachnoid space and thus exclude subdural compartment collections. Controversy arises when SDH is detected in association with these systematic subarachnoid spaces Fig 6.

There are authors who posit that in the context of benign expanded trauma spaces that SDH can occur spontaneously or with minimal trauma. Therefore, in my clinical and, the detection of SDH in association subdural benign expanded subarachnoid CSF collections warrants a hemorrhage child protection trauma evaluation.

Subdural hematoma (SDH) and epidural hematoma are prognostic factors in acute subdural haematomas: the value of the ‘worst’ CT scan.

This is a preview of subscription content, log in to check access. Rent this article via DeepDyve. Adamsbaum C, Morel B, Ducot B et al Dating the abusive head trauma episode and perpetrator statements: key points for imaging. Pediatr Radiol 44 Suppl 4:S—S J Forensic Sci — Jaspan T Current controversies in the interpretation of non-accidental head injury.

Pediatr Radiol S—S Demaerel P MR imaging in inflicted brain injury. J Neurosurg Pediatr —

Blood dating mri

Clinically silent subdural hemorrhage causes bilateral vocal fold paralysis in newborn infant. Bilateral congenital vocal fold paralysis BVFP may result from multiple etiologies or remain idiopathic when no real cause can be identified. If obstructive dyspnea is significant and requires urgent stabilization of the airway, then intubation is performed first and an MRI of the brain is conducted to rule out an Arnold-Chiari malformation that can benefit from a shunt procedure and thus alleviate the need for a tracheostomy.

Clinically silent subdural hemorrhage without any birth trauma represents another cause of neonatal BVFP that resolves spontaneously within a month. It is of clinical relevance to recognize this potential cause of BVFP as its short duration may alleviate the need for a tracheostomy. In this article, we present such a case and review the literature to draw the otolaryngologist’s attention to this possible etiology.

The dating of hemorrhagic lesions when using magnetic resonance (MR) In particular, infants frequently develop subdural hematomas (SDHs), which are.

Imaging CT findings in cases of subdural hematoma after cardiovascular surgery. Initial signs of SDH. A characteristic initial sign of CT findings, as seen in cases of subdural hematoma SDH after cardiovascular surgery, was reported. Central-nervous-system CNS complications after cardiovascular surgery have been thought to be due mainly to the ischemic brain damage caused by both reduced cerebral perfusion pressure and microembolism during extracorporeal circulation.

However, we observed 8 cases of SDH in 39 patients suffering from major CNS complications after cardiovascular surgery. In view of these experiences, SDH was thought to be one of the most significant factors causing CNS complications after cardiovascular surgery. The clinical courses of these four patients were relatively acute or subacute, and the initial small high-density area progressed to definite SDH findings in that region in the follow-up CT.

Although there have been many reports concerning the sequential CT changes in SDH , there has been no report describing the above-mentioned finding. Subdural haemorrhage following endoscopic third ventriculostomy.

Age determination of subdural hematomas with CT and MRI: a systematic review

Read our article and mri scans. Subsequently, subdural masses, also have a chronic subdural hematomas with a large extra-axial hemorrhagic. Unlike ct scan will vary How, also have a buildup of subdural hematoma.

On magnetic resonance imaging these hematomas present as thoracic or lumbar subdural masses, their signal intensity varying with the age of the hematoma.

The timing of the breakdown of red blood cells and organization of hemorrhage has significance in the catabolism of heme and the processing of iron, but also has a practical application in terms of assigning, or attempting to assign, a time course with respect to traumatic events e. Attempts to date contusions, however, have generally been unsuccessful by macroscopic observation, whereas the microscopic observations provide broad data but are also anatomically imprecise as a function of time.

Intracranial lesions are of particular significance with respect to the timing of organizing hemorrhage given the acute, and often life-threatening nature of the hemorrhages, and the medicolegal investigation into potential crimes. Of concern is that the Prussian Blue reaction for iron, a relatively straightforward histochemical reaction that has been in use for over years, is sometimes suggested as a diagnostic test for chronicity.

Therefore, this study examined the utility of the Prussian Blue iron stain in living patients with intracranial hemorrhages and well-defined symptom onset, to test whether the presence of Prussian Blue reactivity could be correlated with chronicity. It was found that out of 12 cases with intracranial hemorrhage, eight cases showed at least focal iron reactivity. In conclusion, the Prussian Blue reaction was unreliable as an indicator of timing in intracranial hemorrhage.

The use of the Prussian blue reaction as an independent indicator of chronicity is therefore not valid and can be misleading. Caution is indicated when employing iron staining for timing purposes, as its only use is to highlight, as opposed to identify, pre-existing lesions. With respect to brain lesions, the Prussian blue reaction should not be used in place of the clinical timing of the neurologic decline, or clinical data that is otherwise more accurate and less susceptible to false positive results.

The timing of various pathologic and molecular changes associated with organizing hemorrhage is complex and incompletely understood, yet a detailed understanding of those changes is critical and often presumed in medicolegal investigation of traumatic injuries. Of particular interest historically has been the gross assessment of contusions, which show a stepwise progression of color change as a function of time, implicating catabolism of heme and the elaboration of bile, hemosiderin, and hematoidin, and other pigmented byproducts [ 1 ].

Numerous studies, however, have highlighted the subjectivity and lack of accuracy in the gross or clinical assessment of contusions [ 2 – 8 ].

MRI findings of different stages of haemorrhage


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