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Child Abuse Case 1

A 10-month-old baby is brought to the ED because of irritability and vomiting. His mother states that he has not been well for the past 5 days. She relates that she fell asleep 5 days ago with the baby on the bed with her and that she awakened after hearing a thump on the floor. The baby cried right away. She brought him to the ED the next day because he vomited once and she became worried. After waiting for 3 hours, she left with the baby without being seen by a physician. The next day, the mom brought the baby to the primary care doctor who reassured her that the baby looked fine. Over the next 2 days he became progressively irritable and then started to vomit repeatedly. In the ED, a CT scan was obtained.

Head Trauma

Which of the following statements is true?

  1. The CT demonstrates heterogeneity of bilateral subdural hemorrhages.
  2. The CT scan demonstrates a common finding after a short fall.
  3. The CT shows that midline structures are shifted, suggesting increased intracranial pressure.
  4. The CT shows subarachnoid hemorrhage because subdural hemorrhages frequently resorb within 2-3 days after bleeding.


The answer is A.

The CT scan shows bifrontal subdural hemorrhages, with the right appearing more hyperintense and the left more grey/iso-intense. Although it is not obvious on this cut, the baby had a skull fracture in the right temporal area. Subdural hemorrhages are uncommon findings after short falls. Epidural or even subarachnoid hemorrhages are more commonly "contact" injuries from short falls.

There is no midline shift.

Subarachnoid hemorrhages frequently resorb within 2-3 days after bleeding, not subdural hemorrhages. Subdural hemorrhages may be present for weeks and become chronic findings.

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