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Review
. 2021 Oct;110(10):2686-2694.
doi: 10.1111/apa.15908. Epub 2021 May 20.

Thrombosis is not a marker of bridging vein rupture in infants with alleged abusive head trauma

Sverre Morten Zahl  1 , Julie A Mack  2 , Cyrille Rossant  3 , Waney Squier  4 , Knut Wester  5
Affiliations
Review

Thrombosis is not a marker of bridging vein rupture in infants with alleged abusive head trauma

Sverre Morten Zahl et al. Acta Paediatr. 2021 Oct.

Abstract

Aim: Thrombosis of bridging veins has been suggested to be a marker of bridging vein rupture, and thus AHT, in infants with subdural haematoma.

Methods: This is a non-systematic review based on Pubmed search, secondary reference tracking and authors' own article collections.

Results: Radiological studies asserting that imaging signs of cortical vein thrombosis were indicative of traumatic bridging vein rupture were unreliable as they lacked pathological verification of either thrombosis or rupture, and paid little regard to medical conditions other than trauma. Autopsy attempts at confirmation of ruptured bridging veins as the origin of SDH were fraught with difficulty. Moreover, microscopic anatomy demonstrated alternative non-traumatic sources of a clot in or around bridging veins. Objective pathological observations did not support the hypothesis that a radiological finding of bridging vein thrombosis was the result of traumatic rupture by AHT. No biomechanical models have produced reliable and reproducible data to demonstrate that shaking alone can be a cause of bridging vein rupture.

Conclusion: There is no conclusive evidence supporting the hypothesis that diagnostic imaging showing thrombosed bridging veins in infants correlates with bridging vein rupture. Hence, there is no literature support for the use of thrombosis as a marker for AHT.

Keywords: abusive head trauma; bridging veins; cerebral venous thrombosis; child abuse; subdural haematoma.

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Conflict of interest statement

Julie A. Mack has served as an unpaid expert witness in cases of alleged abuse. Cyrille Rossant is the current president of a French non‐profit organisation (Adikia) providing moral support to parents facing false allegations of child abuse (unpaid activity). Waney Squier has acted as an expert witness, sometimes paid, in cases of suspected child abuse both for the prosecution and for the defence. She was reported to the General Medical Council (the governing body for the doctors in the UK) on the basis of her evidence in shaken baby cases and got her licence suspended, but restored on appeal. Knut Wester has served as a mostly unpaid expert witness for the court and the defence in a few cases of suspected abusive head injury in Norwegian courts. Sverre Morten Zahl declares no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Left‐sided subdural haematoma (arrow) in a 7‐month‐old child as seen on computed tomography. Surgery confirmed rupture of an ipsilateral frontal bridging vein
FIGURE 2
FIGURE 2
(A and B)Magnetic resonance imaging (MRI) of a 26‐day‐old infant with small volume subdural haematoma and fluid. Seizures developed in the hospital and MRI showed clotted cortical veins (arrows) and evolving non‐haemorrhagic infarction. Abuse was initially suggested, but after full evaluation, the charges were dismissed and the child returned to the parents
FIGURE 3
FIGURE 3
(A) Macroscopic view of a large mass of varicose/dilated veins with surrounding subarachnoid blood and local bridging vein thrombosis (white arrows). A section from the area marked with a white box is shown in 3B). (B)Thrombosed vein (V) in the subarachnoid space with surrounding subarachnoid haemorrhage (haematoxylin and eosin stain). (C)Same vein as in B). A defect in the vein wall is seen in the lower left (smooth muscle actin stain, counterstained with haematoxylin and eosin). (D)Higher magnification of vein wall stained with smooth muscle actin (muscle cells are brown, red blood cells are blue). Red blood cells are seen passing between the muscle cells of the vein wall (diapedesis) (smooth muscle actin stain, counterstained with haematoxylin and eosin)
See this image and copyright information in PMC

Comment in

References

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