Abusive head trauma: don’t overlook bridging vein thrombosis

Few paediatric diagnoses generate as much controversy as abusive head trauma (AHT), also known as shaken baby/shaken impact syndrome (or SBS). Major signs such as multifocal subdural haematomas, cerebral injury, retinal haemorrhage and skeletal fractures are exhaustively described in myriad radiological reports, and are the result of extremely violent trauma. While bruises have significant diagnostic value, they may be missed when located in hidden areas like behind the ears and in the axilla. In some cases, subdural haematomas appear to be isolated, with no other apparent signs, making diagnosis difficult. We would like to stress the need for careful vertex screening to look for bridging vein thrombosis, which—as some pathologists have pointed out—has high diagnostic value [1]. The bridging veins are draining veins that arise from the coalescence of the superficial cortical venous network at the midline, within the subarachnoid space. They extend, bridge-like, at intervals along the midline, from their attachment to the arachnoid at the medial border of the cerebral hemispheres to the superior sagittal sinus of the dura mater, into which they flow after having traversed the arachnoid space and the deep layers of the dura mater [2]. These veins constitute a short, non-tortuous, perpendicular pipeline between the