Title: Increasing the evidence base for the cause of subdural haemorrhage and the source of bleeding in paediatric head injury
Funder: The Academy of Medical Sciences

Abstract: The most common cause of subdural haemorrhage (SDH) is head injury. In the adult population, a SDH may occur after a fall or following a road traffic accident. In infants, SDH is commonly seen (90% of cases) in cases of abusive head trauma (AHT). This term is used to describe a constellation of findings that are suggestive of a baby being subjected to repetitive rotational and acceleration/deceleration forces within the head (shaking), with or without an additional impact. The majority of medical professionals agree that the source of SDH in AHT is traumatic damage to blood vessels known as bridging veins (BVs), which traverse from the brain to the dura. However, there is a paucity of anatomical and microscopic descriptions of infant BVs in the scientific and medical literature and demonstrations of traumatically damaged infant veins are rare. Establishing a diagnosis of AHT can be very challenging. The proposed research study aims to increase the evidence base for AHT through the development of post-mortem and laboratory techniques for the anatomical characterisation of BVs and the detection of traumatic damage to these blood vessels. Objectives 1. Microscopic characterisation of BVs sampled during adult and child post-mortem examinations. 2. Development of a perfusion technique to identify damaged BVs during post-mortems by extravasation of labelled solutions at sites of injury/rupture. 3. Targeted retention of damaged BVs from cases of head injury to develop diagnostic imaging protocols for the detection of damage due to trauma.

Lay abstract: Abusive head trauma (AHT) is a term used to describe an infant who has been injured due to violent shaking and/or a heavy blow to the head. Shaking produces dangerous forces, which move the very soft brain inside the baby’s skull. When this occurs, the baby develops bleeding inside the head called subdural haemorrhage (SDH). The SDH is thought to occur due to damaged blood vessels inside the head known as bridging veins (BVs). SDH is the most common finding in AHT, alongside a swollen brain and bleeding in the eyes. Although some babies may have other indicators of abuse, such as bruising or broken bones, in some cases, these findings are absent. This can make it more difficult to prove whether or not a baby has suffered abuse. Accurate diagnosis is essential during court proceedings to provide justice for AHT victims, protect against future abuse and to guard against any unjustified loss of parental rights or imprisonment. On occasion, a doctor or lawyer may suggest a non-violent theory for an infant SDH. It is therefore crucial that traumatic damage to BVs can be demonstrated to prove that a baby has been abused. This study aims to compare the microscopic structure of BVs from deceased individuals who have suffered a SDH with those who have not, thereby enhancing our understanding of normal and damaged veins. This work has clear implications for the guidance of doctors performing post-mortems/acting as expert witnesses and lawyers who will be prosecuting/defending AHT cases.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: NEUROLOGICAL;CARDIOVASCULAR