In describing a 10-month-old boy with bilateral calcified subdural hematomas, Mohammed Al Wohaibi and associates1 report that the hematomas, which occurred after replacement shunting at 4 months of age, calcified intensely within a period of 6 months. They discuss trauma, as well as infection and overshunting, as a possible cause of subdural hemorrhages in general, but state that the mechanism for the underlying calcifications remains unclear.
The possibility of shaken baby syndrome should be considered in this case. A baby with special needs, such as this infant, might well be an increased burden and source of stress for caregivers. Two recent reports attest to a lack of recognition by physicians of occult head injury.2,3 The babies may present with nonspecific symptoms, and the results of general and neurological examinations at the time of presentation may be normal. However, consideration of this diagnosis might prevent possible further injury or death.
Susan Bennett Amy Plint Department of Pediatrics Michael Vassilyadi Division of Neurosurgery Children's Hospital of Eastern Ontario Ottawa, Ont.
References
- 1.Al Wohaibi M, Russell N, Al Ferayan A. A baby with an armoured brain. CMAJ 2003;169(1):46-7. [PMC free article] [PubMed]
- 2.Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA 1999;281(7):621-2. [DOI] [PubMed]
- 3.Rubin DM, Christian CW, Bilaniuk LT, Zazyczny KA, Durbin DR. Occult head injury in high-risk abused children. Pediatrics 2003; 111 (6): 1382-6. [DOI] [PubMed]