Original Article| Volume 72, P31-35, July 2017

In Vivo Demonstration of Traumatic Rupture of the Bridging Veins in Abusive Head Trauma



      In victims of abusive head trauma, bridging vein thrombosis is a common finding on magnetic resonance imaging. We aimed to evaluate the utility of high-resolution coronal susceptibility-weighted imaging (SWI) in depicting bridging vein thrombosis as well as to verify the morphology of the bridging vein thrombosis on axial SWI. We additionally analyzed the correlations between bridging vein thrombosis or bridging vein deformation and other magnetic resonance imaging findings that often occur in association with abusive head trauma.


      Seventeen patients with abusive head trauma were retrospectively evaluated for the presence of thrombosis on axial SWI. The affected veins were localized on coronal SWI, and the strength of association between the presence of bridging vein thrombosis on axial versus high-resolution coronal SWI was determined.


      Of 11 patients identified with thrombosis on axial SWI, high-resolution coronal SWI verified bridging vein thrombosis in four individuals (36%). The previously reported “tadpole sign” on axial images did not predict bridging vein thrombosis on coronal SWI (odds ratio = 0.3 [0.02, 5.01], P = 0.538). Volumetric coronal SWI disclosed additional irregularities of the bridging vein walls which was associated with the presence of subdural hematoma on magnetic resonance imaging (P = 0.03), suggesting traumatic injury.


      Coronal SWI confirmed thrombosis of the bridging veins only in a minority of cases. Diffusely irregular contours of the veins observed on high-resolution coronal SWI was a major finding in our study. Disruption of the normal anatomy of the bridging veins in abusive head trauma further supports the traumatic nature of the disease.


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        • Shanahan M.E.
        • Zolotor A.J.
        • Parrish J.W.
        • Barr R.G.
        • Runyan D.K.
        National, regional, and state abusive head trauma: application of the CDC algorithm.
        Pediatrics. 2013; 132: e1546-e1553
        • Leeper C.M.
        • Nasr I.
        • McKenna C.
        • Berger R.P.
        • Gaines B.A.
        Elevated admission international normalized ratio strongly predicts mortality in victims of abusive head trauma.
        J Trauma Acute Care Surg. 2016; 80: 711-716
        • Acker S.N.
        • Roach J.P.
        • Partrick D.A.
        • Karrer F.M.
        • Bensard D.D.
        • Sirotnak A.P.
        Beyond morbidity and mortality: the social and legal outcomes of non-accidental trauma.
        J Pediatr Surg. 2015; 50: 604-607
        • Maguire S.A.
        • Kemp A.M.
        • Lumb R.C.
        • Farewell D.M.
        Estimating the probability of abusive head trauma: a pooled analysis.
        Pediatrics. 2011; 128: e550-e564
        • Adamsbaud C.
        • Rambaud C.
        Abusive head trauma: don't overlook bridging vein thrombosis.
        Pediatr Radiol. 2012; 42: 1298-1300
        • Maxeiner H.
        Demonstration and interpretation of bridging vein ruptures in cases of infantile subdural bleedings.
        J Forensic Sci. 2001; 46: 85-93
        • Stein K.M.
        • Ruf K.
        • Ganten M.K.
        • Mattern R.
        Representation of cerebral bridging veins in infants by postmortem computed tomography.
        Forensic Sci Int. 2006; 163: 93-101
        • Morad Y.
        • Kim Y.
        • Armstrong D.
        • Huyer D.
        • Mian M.
        • Levin A.
        Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome.
        Am J Ophthalmol. 2002; 134: 354-359
        • Levin A.V.
        Retinal hemorrhage in abusive head trauma.
        Pediatrics. 2010; 126: 961-970
        • Barlow K.M.
        • Minns R.A.
        Annual incidence of shaken impact syndrome in young children.
        Lancet. 2000; 356: 1571-1572
        • Yamashima T.
        • Friede R.L.
        Why do bridging veins rupture into the virtual subdural space?.
        J Neurol Neurosurg Psychiatry. 1984; 47: 121-127
        • Christian C.W.
        • Block R.
        • Committee on Child Abuse and Neglect
        • American Academy of Pediatrics
        Abusive head trauma in infants and children.
        Pediatrics. 2009; 123: 1409-1411
        • Hahnemann M.L.
        • Kinner S.
        • Schweiger B.
        • et al.
        Imaging of bridging vein thrombosis in infants with abusive head trauma: the “Tadpole Sign”.
        Eur Radiol. 2015; 25: 299-305
        • Tong K.A.
        • Ashwal S.
        • Obenaus A.
        • Nickerson J.P.
        • Kido D.
        • Haackie E.M.
        Susceptibility-weighted MR imaging: a review of clinical applications in children.
        AJNR Am J Neuroradiol. 2008; 29: 9-17
        • Haacke E.M.
        • Xu Y.
        • Cheng Y.C.
        • Reichenbach J.R.
        Susceptibility weighted imaging (SWI).
        Magn Reson Med. 2004; 52: 612-618
        • Yilmaz U.
        • Körner H.
        • Meyer S.
        • Reith W.
        Multifocal signal loss at bridging veins on susceptibility-weighted imaging in abusive head trauma.
        Clin Neuroradiol. 2015; 25: 181-185
        • Zuccoli G.
        • Panigrahy A.
        • Haldipur A.
        • et al.
        Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma.
        Neuroradiology. 2013; 55: 889-893
        • Piteau S.J.
        • Ward M.G.K.
        • Barrowman N.J.
        • Plint A.C.
        Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review.
        Pediatrics. 2012; 130: 315-323
        • Maxeiner H.
        Detection of ruptured cerebral bridging veins at autopsy.
        Forensic Sci Int. 1997; 89: 103-110
        • Choudhary A.K.
        • Bradford R.
        • Dias M.S.
        • Thamburaj K.
        • Boal D.K.
        Venous injury in abusive head trauma.
        Pediatr Radiol. 2015; 45: 1803-1813