Is bridging vein rupture/thrombosis associated with subdural hematoma at birth?
Is bridging vein rupture/thrombosis associated with subdural hematoma at birth?
复制标题
DOI：
10.1007/s00247-021-05255-w
复制
发表时间：
2022-01-06
影响因子：
2.3
通讯作者：
Adamsbaum, Catherine
中科院分区：
文献类型：
--
作者：
Bartoli, Marion;Mannes, Ines;Adamsbaum, Catherine
背景：婴儿桥静脉破裂/血栓形成和硬膜下血肿的组合最近受到关注，高度提示虐待性头部创伤。虽然硬脑膜下血肿在出生时经常观察到，但在此背景下没有关于桥静脉破裂/血栓形成患病率的既往研究。目的探讨新生儿硬脑膜下血肿与非硬脑膜下血肿桥静脉破裂/血栓形成的发生率。材料和方法本双中心回顾性研究（2012-2019）观察了在新生儿中进行的所有脑部MRI。我们记录了分娩方法、人口统计学数据和颅内损伤，并分析了作为桥静脉破裂/血栓形成潜在标志物的任何颅顶凝块。结果我们分析了412名新生儿的412次MRI。年龄（平均值+/-标准差[SD]）为5.4 +/- 2.2天，312例（76%）婴儿为足月儿（距末次月经38.3 +/- 2.9周）。分娩方式为阴道分娩42%（n=174），剖宫产43%（n=179），未知14%（n=59）。281例MRI中存在硬膜下血肿（68.0%，[95%置信区间= 63.3-72.5]）。6次MRI显示顶部至少有一个血凝块，推测可能是桥接静脉破裂/血栓形成（1.5%，[0.5-3.1%]）。在母体感染的情况下，只有一次MRI显示头顶有两个以上的凝块。这6名婴儿与其他406名婴儿在出生时胎龄、分娩方式、硬膜下血肿或脑实质损伤方面无显著差异。结论出生时桥静脉破裂/血栓形成非常罕见，不太可能与硬膜下血肿有关。
Background The combination of bridging vein rupture/thrombosis and subdural hematoma in infants has recently gained attention as highly suggestive of abusive head trauma. While subdural hematomas are frequently observed at birth, there are no previous studies of bridging vein rupture/thrombosis prevalence in that context. Objective To evaluate the prevalence of bridging vein rupture/thrombosis in newborns with and without subdural hematoma. Materials and methods This bicentric retrospective study (2012-2019) looked at all brain MRIs performed in neonates. We noted delivery method, demographic data and intracranial injuries and analyzed any clots at the vertex as potential markers of bridging vein rupture/thrombosis. Results We analyzed 412 MRIs in 412 neonates. Age was (mean +/- standard deviation [SD]) 5.4 +/- 2.2 days and 312 (76%) infants were full term (38.3 +/- 2.9 weeks from last menstrual period). The delivery method was vaginal birth for 42% (n=174), cesarean section for 43% (n=179), and unknown for 14% (n=59). Subdural hematoma was present in 281 MRIs (68.0%, [95% confidence interval = 63.3-72.5]). Six MRIs showed at least one clot at the vertex, assumed to be possible bridging vein rupture/thrombosis (1.5%, [0.5-3.1%]). Only one MRI showed more than two clots at the vertex, in a context of maternal infection. There was no significant difference in terms of gestational age at birth, delivery method or the presence of subdural hematoma or parenchymal injuries between those 6 infants and the 406 others. Conclusion Bridging vein rupture/thrombosis at birth is very rare and unlikely to be related to subdural hematoma.