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June 1975

Delayed Onset of Acute Post-traumatic Subdural Effusion

Author Affiliations

Pediatric Consultant, Child Protection Team University of Colorado Medical Center 4200 E Ninth Ave Denver, CO 80220

Am J Dis Child. 1975;129(6):749. doi:10.1001/archpedi.1975.02120430081028

Sir.—The purpose of this letter is to suggest that physical abuse was the actual cause behind the subdural hematomas in several of the six cases reported by Gutierrez and Raimondi in the September issue of the Journal (128:327, 1974). The authors attempt to attribute the subdural hematomas to head trauma that occurred 16 to 28 days previously; subdural taps done at the time of the acute injury were negative (five of six cases). The intervening mechanism is not discussed and is apparently mysterious. A mechanism that is well documented and could readily explain the later subdural hematomas is a violent shaking injury.1-3 This inflicted injury leads to tearing of bridging veins with subsequent development of bilateral subdural hematomas. There are no associated scalp swellings, scalp bruises, or skull fractures. More than one half of inflicted subdural hematomas are of this type.1 The authors fail to mention this

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