Inflicted subdural hematomas

A three month old child presented with altered mental status and bulging fontanelle. There was no significant antecedent history given by the caretakers. Computed tomography images (Figures A and B) reveal hemorrhage within the subdural space extending both around the hemisphere and interhemispherically. There is also the question of ischemic changes. Diffusion weighted magnetic resonance imaging (Figure C) performed a few hours later confirm significant ischemic changes. The gradient echo magnetic resonance image (Figure D), sensitive to blood, further defines the hemorrhage in the subdural space. The child was found to have severe bilateral retinal hemorrhages and non-accidental trauma was suspected.