Lack of evidence for a causal relationship between hypoxic-ischemic encephalopathy and subdural hemorrhage in fetal life, infancy, and early childhood

被引:41
作者
Byard, Roger W. [1 ]
Blumbergs, Peter [2 ]
Rutty, Guy [3 ]
Sperhake, Jan [4 ]
Banner, Jytte [5 ]
Krous, Henry F. [6 ,7 ,8 ]
机构
[1] Univ Adelaide & Forens Sci SA, Discipline Pathol, Adelaide, SA, Australia
[2] Hanson Inst Neurol Dis, Adelaide, SA, Australia
[3] Univ Leicester, E Midlands Forens Pathol Unit, Leicester, Leics, England
[4] Univ Hamburg, Med Ctr, Dept Forens Med, Hamburg, Germany
[5] Univ Aarhus, Dept Forens Med, Aarhus, Denmark
[6] Univ Calif San Diego, Sch Med, San Diego, CA 92103 USA
[7] Rady Chinldrens Hosp, Dept Pathol, San Diego, CA USA
[8] San Diego Cty, Off Med Examiner, San Diego, CA USA
关键词
hypoxic-ischemic encephalopathy; non-accidental head injury; shaken infant syndrome; subdural hemorrhage;
D O I
10.2350/06-08-0154.1
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
It has been asserted that hypoxic-ischemic encephalopathy (HIE) with cerebral swelling in the absence of marked trauma may be responsible for subural hemorrhage in the young. As this may have considerable implications in determining both the mechanism of death and the degree of force required to cause injury in certain cases of inflicted head injury in infancy, clarification is required. A retrospective study of 82 fetuses, infants, and toddlers with proven HIE and no trauma was under-taken from forensic institutes in Australia, the United Kingdom, Germany, Denmark, and the United States. The age range was 35 weeks gestation to 3 years, with a male to female ratio of 2:1. All cases had histologically confirmed HIE. Causes of the hypoxic episodes were temporarily resuscitated sudden infant death syndrome with delayed death (N = 30), drowning (N = 12), accidental asphyxia (N = 10), intrauterine/delivery asphyxia (N = 8), congenital disease (N = 6), aspiration of food/gastric contents (N = 4), inflicted asphyxia (N = 3), epilepsy (N = 1), dehydration (N = 1), drug toxicity (N = 1), complications of prematurity (N = 1), and complications of anesthesia (N = 1). The initiating event was not determined in 4 instances. In no case was there macroscopic evidence of subdural hemorrhage. In this study no support could be given to the hypothesis that HIE in the young in the absence of trauma causes subdural hemorrhage.
引用
收藏
页码:348 / 350
页数:3
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