SBS 101
Subdurals
Retinal Hemorrhages
Fractures
Anatomy of an Autopsy
Neuro-Anatomy 101
Biomechanics 101
SBS Myths
Alternate Explanations
Annotated Bibliography
Glossary
False
Assumption #3:
Chronic subdural hematomas cannot rebleed with lesser degrees of trauma.
Truth:
It is undisputed in adult literature that subdurals can rebleed within the
healing course. Medical literature and case studies going back 60+ years
have documented the same processes in pediatric subdural hematomas with
or without known abuse.
Prosecution witnesses in nonaccidental trauma cases have been allowed to testify that chronic subdural hematomas do not rebleed without significant force. This is simply not true. The presence and importance of an old subdural hematoma in these cases is often pathologically misinterpreted. State's experts will, at the same time, deny the vulnerability of an old subdural hematoma, and blame it on the defendant.
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Testimony of Prosecution witness Randall Alexander in People v. Basuta Questioned By Gene Iredale Esq. Q. " Well, what is the relationship of the old subdural hematoma to the present condition …?" A. "It's an indicator of prior injury, in my opinion prior shaken baby syndrome. It does not mean that the forces the second time around are any the less to cause all of these new injuries. You still have to have the same forces. So it doesn't have a significance that way. Its significance is just this is not the first time the similar things have happened. " |
These assumptions are incorrect on their face, but coupled with the fallacy of the impossibility of a lucid interval, they are generally erroneously argued as a factors that lend to the guilt of the immediate caretaker, rather than properly being seen as a factor that might disprove his or her guilt.
Chronic subdural hematomas often rebleed during the regular course of healing. Studies on subdural hematomas indicate that they wax and wane during their healing process and can rebleed with little to no impact (1,2,3). Even prosecution witnesses, when faced with the evidence, will admit that rebleeds can occur.
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Testimony of Randall Alexander: People v. Braddy With Defense Attorney Michael Moore "If you get a subdural in about 10 to 14 days, new blood vessels are forming. The body is trying to absorb the back of the clot you have inside, and new blood vessels are forming. And then the, it doesn't really happen spontaneously, but a minor trauma can come along, a bump or something, and because these are somewhat delicate, the blood vessels, it's possible, you wouldn't usually see it, but it's possible to get some bleeding either within that same blood clot or it can extend just a little bit away from the blood clot itself." (Pg 31, LL 7-15).
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Thus, the identity of the last individual standing with the baby when his or her subdural reaches a critical point, is hardly dispositive of the mechanism of the original trauma or the identity of "the abuser" if there is one. (4)
Think about it! 1) If (even by the testimony of the State's experts) 50% of these cases show evidence of an old subdural hematoma, 2) if (even by the testimony of the states experts) old subdurals can go undetected, or misdiagnosed, 3) if, (even by the testimony of the states experts) subdural hematomas have a progressive discourse that waxes and wanes and can rebleed with little to no trauma, 4) then, in order to be medically and legally valid, the determination of the mechanism or individual that caused the subdural hematoma, MUST be based on some evidence other than who calls 911.
Citations
1. Parent, A.D. Pediatric chronic subdural hematoma: a retrospective comparative analysis. Pediatric Neurosurgery 1992;18:266-271 1992.
2. Piatt J., A pitfall in the Diagnosis of Child Abuse: External Hydrocephalus, Subdural Hematoma & Retinal Hemorrhages. Neurosurgical Focus 1999; 7(4)(4):1-9.
3. Lindenberg, R. Spitz and Fisher: Medicological Investigation of Death. 3rd Edition 1993.
4. Nahelsky, M. and Dix, J. The time interval between lethal infant shaking and onset of symptoms: A review of the Shaken Baby Syndrome Literature. The American Journal of Forensic Medicine and Pathology 1995; 16(2):154-157.