From Pachymeningitis Hemorrhagica to Abusive Head Trauma: A Journey Through the Centuries

Abstract

The development of medical knowledge follows specific principles. These also apply to abusive head trauma. The seminal literature from the early 20^th century is based on earlier research from Europe, which is fundamental to understand the evolution of understanding and nomenclature of abusive head trauma. A review of original medical literature on intracranial injuries in children, published in German, English, and French, was conducted using PubMed and Google Scholar for articles before 1950. The primary search focused on subdural hemorrhages and pachymeningitis in children, followed by a snowball search of references. Full texts of available manuscripts were reviewed. Primary literature as early as 1839 was reviewed by native language speakers, referring to intracranial collections of blood that underwent an evolution in nomenclature and understanding of causation. Initially termed pachymeningitis hemorrhagica, implying an inflammatory cause, the nomenclature evolved to subdural hematoma, as traumatic causes aligned with clinical experience. Advances in diagnostic imaging further enhanced understanding and nomenclature. The clinical findings associated with abusive head trauma have been described for centuries, with consistent signs and symptoms until the present day. As the understanding of the disease evolved due to modern diagnostic techniques, changes in nomenclature became necessary.

Keywords: abusive head trauma; child abuse; medical history; shaken baby syndrome.