‘An Investigation of the Infant Cerebrodual Venous System in Relation to the Source of Subdural Haemorrhage in Paediatric Head Injury’

A common finding in babies who suffer a head injury is subdural haemorrhage (SDH). When an infant presents with SDH, alongside other signs of injury (e.g. retinal haemorrhages, encephalopathy, bone fractures and bruising), the majority of relevant medical professionals would be concerned that the baby could have been subjected to abusive head trauma (AHT). However, the events that lead to a SDH and the source of bleeding have been debated. The most widely assumed source of bleeding is the rupture of bridging veins which extend from the surface of the brain to the dural membrane. There is limited knowledge in the current literature of the infant’s cerebrodural venous system. Autopsy observations at the beginning of this project have subjectively indicated that infant bridging veins are relatively small and delicate. The aim of this project was to attempt to overcome some of the practical and organisational difficulties related to research in the area of paediatric head injury, and to fill the identified gap in the current medical literature. A novel approach to the post-mortem removal of the infant calvarial bones was developed. This made it possible to document and anatomically map the locations, size and numbers of these vessels and also enhanced the ability to observe pathological features of head injury, free from post-mortem artefact. Optical clearing techniques were used alongside optical coherence tomography to image the dural membrane and within the dural venous sinuses. Infant bridging veins were found to be more numerous than previously described, and in locations which have not previously been reported. A proportion of bridging veins were also relatively small and delicate (˂ 0.3mm). These findings may be important in building a more accurate picture of the mechanisms and forces that result in SDH. The new techniques described in this thesis have expanded the scope for future autopsy-based research into AHT.