Subdural hygromas in an infant with suspected abusive head trauma : a case report and literature review

   Abusive head trauma (AHT) is the leading cause of severe traumatic brain injury and trauma-related mortality in infants. Diagnosis is often challenging due to the absence of external signs, resulting in delayed treatment and poor outcomes. Ongoing debates regarding the specificity of the classical AHT triad and the existence of alternative hypotheses (Geddes, Chuchin) highlight the need for analysis of real clinical cases and contemporary classifications. We present a case of a 2-month-old infant with massive bilateral retinal hemorrhages and bilateral subdural hygromas causing marked compression and generalized cerebral ischemia on MRI. The parents denied any traumatic events. No external injuries were detected. Emergency bilateral subdural drainage was performed, yielding hemorrhagic cerebrospinal fluid. Follow-up revealed transformation of hygromas into a homogeneous hematohygroma. Coagulopathies, infections, and venous sinus thrombosis were excluded. The patient was discharged with severe neurological deficit. The evolution of AHT terminology, limitations of the classical triad, alternative hypotheses, and applicability of the classification of subdural collections proposed by Hahnemann et al. (2022) to the presented condition are analyzed. This clinical case demonstrates the diagnostic significance of modern AHT criteria and the Hahnemann classification for verifying the abusive origin of trauma in the absence of external signs and supports the adoption of the term “abusive head trauma” in Russian clinical practice.

1. Scavarda D., Gabaudan C., Ughetto F., Lamy F. Initial predictive factors of outcome in severe non-accidental head trauma in children. Child’s Nervous System. 2010. Doi: 10.1007/s00381-010-1150-x.

2. Jenny C., Hymel K., Ritzen A., Reinert S., Hay T. Analysis of Missed Cases of Abusive Head Trauma. JAMA. 1999;281(7):621–626. Doi: 10.1001/jama.281.7.621.

3. Missouri Child Fatality Review Panel Subcommittee on Child Abuse and Neglect Fatalities. Eliminating Child Abuse and Neglect Fatalities in Missouri: An Executive Report. Jefferson City, MO: Office of Child Advocate, State of Missouri. 2021.

4. Nguyen V. N., Wallace D., Ajmera S., Akinduro O., Smith L. J., Giles K., Vaughn B., Klimo P. Management of Subdural Hematohygromas in Abusive Head Trauma. Neurosurgery. 2020;86(2):281–287. Doi: 10.1093/neuros/nyz076. PMID: 31321424.

5. Jun Beom Cho, Hong Cho. Surgical Treatment of Subdural Hygromas in Infants and Children. J Korean Neurosurg. 2005;(38).

6. Kasim A. K., Almamoun M. M., Kenawy K. Management of Subdural Hygroma in Infants and Children. Al-Azhar International Medical Journal. 2022;3(3):136–144. Doi: 10.21608/aimj.2022.116705.1796.

7. Hung K.-L. Pediatric abusive head trauma. Biomed J. 2020;43(3):240–250. Doi: 10.1016/j.bj.2020.03.008.

8. Duncea R. M., Apostol I., Calota R. G., Belis V. Forensic and Clinical Diagnosis in “Shaken Baby Syndrome”, Between Child Abuse and Iatrogenic Abuse. Journal of Mind and Medical Sciences. 2017;4(1):13–18. Doi: 10.22543/7674.41.P1318.

9. Christian C. W., Block R. Abusive head trauma in infants and children. Pediatrics. 2009;123(5):1409–1411. Doi: 10.1542/peds.2009-0408.

10. Kryukov A. E., Rusanov S. N. Features of pediatric traumatic brain injury. Meditsinskaya sestra. 2016;(1):20–23. (In Russ.)

11. Kukuyuk T. V., Gromakina E. V., Basova G. G. Ocular manifestations in child shaking syndrome. Fundamental and Clinical Medicine. 2016;1(3):97–101. (In Russ.)

12. Gimaldinova N. E., Ignat’eva E. N., Lubovceva L. A., Vorob’eva O. V. Pathomorphological features of baby s haking syndrome. Forensic Medical Expertise. 2020;63(3):19–22. (In Russ.) Doi: 10.17116/sudmed20206303119.

13. Zykov V.V. Forensic medical and clinical aspects of diagnosing shaken baby syndrome. Vyatsky Medical Bulletin. 2018;1(57):65–67. (In Russ.)

14. Krishnaprasadh D., Joyce T., Huecker M. R. Pediatric abusive head trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available at: http://www.ncbi.nlm.nih.gov/books/NBK499836/ [Accessed 26 January 2026].

15. Abusive Head Trauma. American Academy of Pediatrics. Available at: https://www.aap.org/en/patient-care/child-abuse-and-neglect/abusive-head-trauma/ (accessed January 26, 2026).

16. Palusci V., Bishop P. What have we learned about child maltreatment fatality prevention? Author Note. The Advisor. 2025;(38):13–35.

17. Rumyantsev A.G., Dreval O.N., Feniksov V.M. Shaken Baby syndrome: diagnosis, treatment, prevention. Questions of Practical Pediatrics. 2007;2(2):23–29. (In Russ.)

18. Feld K., Gresser U., Banaschak S. et al. Fractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study. Int J Legal Med. 2022;136(2):591–601. Doi: 10.1007/s00414-021-02751-4.

19. Wittschieber D., Karger B., Pfeiffer H., Hahnemann M. L. Understanding subdural collections in pediatric abusive head trauma. AJNR Am J Neuroradiol. 2019;40(3):388–395. Doi: 10.3174/ajnr.A5855.

20. Leventhal J. M., Asnes A. G., Pavlovic L., Moles R. L. Diagnosing abusive head trauma: the challenges faced by clinicians. Pediatr Radiol. 2014;44(Suppl. 4):S537–S542. Doi: 10.1007/s00247-014-3074-1.

21. Levin A. V. Retinal hemorrhage in abusive head trauma. Pediatrics. 2010;126(5):961–970. Doi: 10.1542/peds.2010-1220.

22. Narang S. K., Fingarson A., Lukefahr J. et al. Abusive head trauma in infants and children : Technical report. Pediatrics. 2025;155(3):e2024070457. Doi: 10.1542/peds.2024-070457.

23. Debelle G. D., Maguire S., Watts P., Hernandez R. N., Kemp A. M. Abusive head trauma and the triad: a critique on behalf of RCPCH of “Traumatic shaking: the role of the triad in medical investigations of suspected traumatic shaking”. Arch Dis Child. 2018;103(6):606–610. Doi: 10.1136/archdischild-2017-313855.

24. Geddes J. F., Hackshaw A. K., Vowles G. H., Nickols C. D., Whitwell H. L. Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in “shaken baby syndrome”? Neuropathol Appl Neurobiol. 2003;29(1):14–22. Doi: 10.1046/j.1365-2990.2003.00434.x.

25. Richards P. G., Bertocci G. E., Bonshek R. E. et al. Shaken baby syndrome. Arch Dis Child. 2006;91(3):205–206. Doi: 10.1136/adc.2005.090761.

26. Chuchin M. Yu. Shaken baby syndrome: diagnosis and treatment of cerebral injuries. Pediatria. Journal named after G. N. Speransky. 2011;90(6):46–54. (In Russ.)

27. Hahnemann M. L., Wittschieber D., Karger B. et al. Characterization of subdural collections in initial neuroimaging of abusive head trauma: implications for forensic age diagnostics and clinical decision-making. Eur J Radiol. 2023;(159):110652. Doi: 10.1016/j.ejrad.2022.110652.

28. Cartocci G., Fineschi V., Padovano M., Scopetti M., Rossi-Espagnet M. C., Giannì C. Shaken baby syndrome: magnetic resonance imaging features in abusive head trauma. Brain Sci. 2021;11(2):179. Doi: 10.3390/brainsci11020179.