Citation

Akalan N. Acta Neurochir. (Wien) 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00701-021-04792-5

PMID

34767094

Abstract

This is a retrospective review of 28 infants collected from two different countries and institutions whom their caregivers had been convicted of "child abuse." The purpose, descriptions, and the conclusion are well accepted but the article as a whole is rather confusing for the general neurosurgical community. The authors speculate that the terms, "benign enlargement of the subarachnoid spaces (BESS)" and subdural collections are sometimes misdiagnosed leading serious medico-legal problems. Subdural collections represent various conditions which are used interchangeably such as subdural hygroma, chronical subdural hematoma, and external hydrocephaly [1,2,3]. BESS and subdural collections have the common presentation, macrocephaly. Enlargement of subarachnoid spaces in infancy is the most common cause of macrocephaly and characterized clinically with large head circumference, normal or mildly motor and language delay, and increased cerebrospinal fluid (CSF) in the subarachnoid space [2]. Nevertheless, BESS has been commonly regarded as a reversible, self-limiting condition where infants presenting even with motor/neurocognitive delay are reported to catch their peers by the age of 2 years [2,3,4,5,6]. On the other hand, subdural effusions definitely require trauma to develop. Fluid accumulation within the subdural space is either CSF penetrating through an arachnoidal tear following trauma or more likely acute subdural bleeding. Infants with macrocephaly due to chronic subdural collections are more likely to be chronically ill with failure to thrive and developmental delay, with full fontanelles and seizures on presentation...

Language: en