1338. Spinal Subdural Hematoma in Non-Accidental Trauma: Common but Unexplained

Authors: Shobhan H. Vachhrajani, MD, PhD, FRCSC ; Annie Cavalier, BA; Kambiz Kamian, MD, FRCSC; Robert Lober, MD, PhD (Dayton, OH)

Introduction:

Non-accidental trauma (NAT) remains common in infants under one year of age.  We routinely investigate all patients with suspected abusive head trauma (AHT) with MRI of the spine, with some patients demonstrating mechanistically unexplained spinal subdural hematoma (sSDH).  We reviewed our series of patients attempting to better understand its pathogenesis.

Methods:

We queried our institutional trauma database for suspected NAT patients who underwent MRI scan.  From this group, six patients were identified with sSDH.  Demographic information, injury mechanism, identified injuries, NAT predictors, and outcome information were collected.  IRB approval was obtained.

Results:

Five patients suffered NAT and had sSDH; the sixth patient had spontaneous sSDH secondary to vitamin K deficiency.  Age range of injured children was 25 days to 7 months.  All children had known socioeconomic risk factors for NAT.  Shaking and dropping were confessed mechanisms in two patients; injury mechanism was unknown in the remainder.  One patient had long bone and healing rib fractures.  Only one had posterior fossa hemorrhage; the rest had isolated supratentorial hemorrhage.    One patient had sSDH that extended from C5-L5; the rest had varying combinations of cervicothoracic and thoracolumbar SDH.  Spinal SDH was not contiguous with intracranial hemorrhage in any patients.  No patients required surgical intervention for sSDH, and no patients had attributable deficits at follow up.

Conclusion:

Spinal SDH is a known manifestation of NAT.  The pathogenesis remains unexplained, given that they are non-contiguous with intracranial hemorrhage, and the mechanism of NAT is often not available.  We recommend routine MRI spine in suspected NAT and AHT patients in order to further document burden of injury.  Further study, including laboratory simulation, might be necessary to better understand the mechanism of sSDH in NAT.