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External hydrocephalus and subdural bleeding in infancy associated with transplacental anti-Ro antibodies
  1. R J Edwards1,
  2. T D Allport2,
  3. N G Stoodley3,
  4. F O'Callaghan4,
  5. R J Lock5,
  6. M R Carter1,
  7. A V Ramanan6
  1. 1Department of Neurosurgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK
  2. 2Consultant Community Paediatrician, Bristol Royal Hospital for Children, Bristol, UK
  3. 3Department of Neuroradiology, North Bristol NHS Trust, Bristol, UK
  4. 4Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK
  5. 5Department of Immunology and Immunogenetics, North Bristol NHS Trust, Bristol, UK
  6. 6Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Mr Richard J Edwards, Consultant Paediatric Neurosurgeon, Department of Neurosurgery, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK; r.j.edwards{at}


Background The isolated finding of an unexplained chronic subdural haematoma in an infant may suggest non-accidental head injury (NAHI). The authors report a previously undescribed cause of multifocal chronic subdural haematoma in infancy which could result in a misdiagnosis of previous NAHI.

Methods Two infants, aged 3 and 4 months of age, presented with progressively increasing head circumference measurements from birth. There was no history of encephalopathy. Retinal haemorrhages were not present. CT and MRI demonstrated bilateral subdural fluid collections over the frontal regions that were consistent with either chronic subdural haematomas or haemorrhagic subdural effusions. In view of the possibility of NAHI, child protection investigations were initiated.

Findings In neither case did the child protection investigations raise concerns. Comprehensive investigations for known haematological and metabolic disorders associated with subdural haematomas or effusions in infants were all normal. In both cases the infant's mother had a history of Sjögren's syndrome and both infants had positive anti-Ro antibody at presentation.

Conclusions Transplacental acquisition of anti-Ro antibodies has been associated with external hydrocephalus. External hydrocephalus has been recognised as a predisposing factor for subdural haemorrhage. These are the first reported cases linking the presence of anti-Ro antibodies and external hydrocephalus with subdural fluid collections in infancy.

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  • Competing interests RJE, TDA, NGS, MRC, FO'C act as expert witnesses in child protection cases usually as single joint experts and they have also given evidence in criminal cases both for the prosecution and the defence.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.