Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections

Jacqueline Tucker Pennsylvania State University, State College; 

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Arabinda Kumar Choudhary Department of Radiology and
Departments of Radiology and

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Joseph Piatt Nemours Neuroscience Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
Neurological Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; and

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OBJECTIVE

Benign enlargement of the subarachnoid spaces (BESS) is a common finding on imaging studies indicated by macrocephaly in infancy. This finding has been associated with the presence of subdural fluid collections that are sometimes construed as suggestive of abusive head injury. The prevalence of BESS among infants with macrocephaly and the prevalence of subdural collections among infants with BESS are both poorly defined. The goal of this study was to determine the relative frequencies of BESS, hydrocephalus, and subdural collections in a large consecutive series of imaging studies performed for macrocephaly and to determine the prevalence of subdural fluid collections among patients with BESS.

METHODS

A text search of radiology requisitions identified studies performed for macrocephaly in patients ≤ 2 years of age. Studies of patients with hydrocephalus or acute trauma were excluded. Studies that demonstrated hydrocephalus or chronic subdural hematoma not previously recognized but responsible for macrocephaly were noted but not investigated further. The remaining studies were reviewed for the presence of incidental subdural collections and for measurement of the depth of the subarachnoid space. A 3-point scale was used to grade BESS: Grade 0, < 5 mm; Grade 1, 5–9 mm; and Grade 2, ≥ 10 mm.

RESULTS

After exclusions, there were 538 studies, including 7 cases of hydrocephalus (1.3%) and 1 large, bilateral chronic subdural hematoma (0.2%). There were incidental subdural collections in 21 cases (3.9%). Two hundred sixty-five studies (49.2%) exhibited Grade 1 BESS, and 46 studies (8.6%) exhibited Grade 2 BESS. The prevalence of incidental subdural collections among studies with BESS was 18 of 311 (5.8%). The presence of BESS was associated with a greater prevalence of subdural collections, and higher grades of BESS were associated with increasing prevalence of subdural collections. After controlling for imaging modality, the odds ratio of the association of BESS with subdural collections was 3.68 (95% CI 1.12–12.1, p = 0.0115). There was no association of race, sex, or insurance status with subdural collections. Patients with BESS had larger head circumference Z-scores, but there was no association of head circumference or age with subdural collections. Interrater reliability in the diagnosis and grading of BESS was only fair.

CONCLUSIONS

The current study confirms the association of BESS with incidental subdural collections and suggests that greater depth of the subarachnoid space is associated with increased prevalence of such collections. These observations support the theory that infants with BESS have a predisposition to subdural collections on an anatomical basis. Incidental subdural collections in the setting of BESS are not necessarily indicative of abusive head injury.

ABBREVIATIONS

BESS = benign enlargement of the subarachnoid spaces; SSFSE = single-shot fast spin echo; US = ultrasound.
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  • 1

    Alper G, , Ekinci G, , Yilmaz Y, , Arikan C, , Telyar G, & Erzen C: Magnetic resonance imaging characteristics of benign macrocephaly in children. J Child Neurol 14:678682, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Azais M, & Echenne B: [Idiopathic pericerebral swelling (external hydrocephalus) of infants.]. Ann Pediatr (Paris) 39:550558, 1992. (Fr)

  • 3

    Gout A, , Gautier I, , Bellaiche M, , Pinard JM, , Tremon M, & Rodriguez D, et al.: [Idiopathic pericerebral enlargement in infants: simple anatomical variant or hemorrhagic risk factor?]. Arch Pediatr 4:983987, 1997. (Fr)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Greiner MV, , Richards TJ, , Care MM, & Leach JL: Prevalence of subdural collections in children with macrocrania. AJNR Am J Neuroradiol 34:23732378, 2013

  • 5

    Laubscher B, , Deonna T, , Uske A, & van Melle G: Primitive megalencephaly in children: Natural history, medium term prognosis with special reference to external hydrocephalus. Eur J Pediatr 149:502507, 1990

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Libicher M, & Tröger J: US measurement of the subarachnoid space in infants: normal values. Radiology 184:749751, 1992

  • 7

    McKeag H, , Christian CW, , Rubin D, , Daymont C, , Pollock AN, & Wood J: Subdural hemorrhage in pediatric patients with enlargement of the subarachnoid spaces. J Neurosurg Pediatr 11:438444, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    McNeely PD, , Atkinson JD, , Saigal G, , O'Gorman AM, & Farmer JP: Subdural hematomas in infants with benign enlargement of the subarachnoid spaces are not pathognomonic for child abuse. AJNR Am J Neuroradiol 27:17251728, 2006

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Medina LS, , Frawley K, , Zurakowski D, , Buttros D, , DeGrauw AJ, & Crone KR: Children with macrocrania: clinical and imaging predictors of disorders requiring surgery. AJNR Am J Neuroradiol 22:564570, 2001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Mori K, , Sakamoto T, , Nishimura K, & Fujiwara K: Subarachnoid fluid collection in infants complicated by subdural hematoma. Childs Nerv Syst 9:282284, 1993

  • 11

    Papasian NC, & Frim DM: A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma. Pediatr Neurosurg 33:188193, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Raul JS, , Roth S, , Ludes B, & Willinger R: Influence of the benign enlargement of the subarachnoid space on the bridging veins strain during a shaking event: a finite element study. Int J Legal Med 122:337340, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Ravid S, & Maytal J: External hydrocephalus: a probable cause for subdural hematoma in infancy. Pediatr Neurol 28:139141, 2003

  • 14

    Vinchon M, , Delestret I, , DeFoort-Dhellemmes S, , Desurmont M, & Noulé N: Subdural hematoma in infants: can it occur spontaneously? Data from a prospective series and critical review of the literature. Childs Nerv Syst 26:11951205, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Wittschieber D, , Karger B, , Niederstadt T, , Pfeiffer H, & Hahnemann ML: Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications. AJNR Am J Neuroradiol 36:432439, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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