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A case for an in utero etiology of chronic SDH/effusion of infancy (letter)

Journal of Perinatology volume 32, pages 79–81 (2012)Cite this article

We read with interest the Perinatal/Neonatal Case Presentation involving a 3-month-old infant with new onset seizures who reportedly was discovered to have a chronic subdural hematoma (CSDH)1 after having ‘new onset partial complex seizures’. The infant, a dichorionic–dizygotic twin (twin A), was noted to have a large head circumference and bulging fontanelle. The infant was noted to have retinal hemorrhages and had his CSDH drained of ‘xanthochromic fluid with some fresh blood’, which was ‘under very high pressure’. The author concluded that the infant's intracranial findings were the result of an in utero ‘process’ as opposed to a postnatal traumatic event. Although the case presented is intriguing, we have concerns about the case vignette and the interpretation of the data presented that make it difficult for us to draw any meaningful conclusions.

The vignette presented is apparently from a case that the author reviewed for a legal process and was not an infant whom he provided care for. The author reports that a review of the prenatal records supports the infant's CSDH being from an in utero origin. The support for this conclusion is based upon comparison of the intrauterine growth pattern and head shape of the twins. It is unclear how this conclusion can be supported. The author reports a ‘superb series’ of prenatal ultrasounds that demonstrate an accelerating intrauterine growth of twin A as compared with twin B. The author reports a ‘mathematical analysis’ that includes a ‘‘head/body’ disproportion’ comparison index. As the mathematical analysis presented is not the one clinically used in assessing fetal growth, the value of this metric in clinical practice is unclear. The author reports that the twin B is ‘healthy by all accounts’ but includes no data to support claim. As the author points out, the twins are dizygotic (fraternal) and, therefore, comparing their growth with each other is no more meaningful than comparing the growth patterns of siblings from different pregnancies. As twin A and twin B are genetically different, their growth, relative to each other, contributes little to our understanding of the intracranial process in twin A.

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Authors and Affiliations

  1. Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, University of Texas Health Science Center, Houston, TX, USA

    C Greeley

  2. Imaging and Pediatrics, University of Texas Health Science Center, Houston, TX, USA

    S John

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  1. C Greeley
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  2. S John
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Correspondence to C Greeley.

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Greeley, C., John, S. A case for an in utero etiology of chronic SDH/effusion of infancy (letter). J Perinatol 32, 79–81 (2012). https://doi.org/10.1038/jp.2011.77

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