gms | German Medical Science

Objective: Head injury is common in children with an estimated annual incidence of 400 per 100,000 in the UK. Head injuries in children are typically due to falls, however a certain number can be non-accidental injuries (NAI). NAI in children is relatively common with an incidence rate of 14-40 cases per 100,000 under the age of 1 and the leading cause of death and disability in the under 1 age group (1,2). The falx cerebri is composed of anterior and posterior parts, that join to form a single midline structure. We present a case of an anatomical variation of the falx cerebri diagnosed radiologically, that presented with subdural haemorrhage that may be confused into the category of NAI.

Methods: A literature review was conducted using pubmed. CT & MRI scans were used to aid the diagnosis.

Results: A literature review revealed two documented cases of absent anterior cerebral falx in adults. No cases were found in children. Baby A's blood test (FBC, U&E's and Coagulation) were normal. An US Scan on admission revealed prominent extra-axial spaces. A CT scan revealed bilateral hypodense frontal parietal temporal subdural collections. There was no evidence of a scalp haematoma or a skull fracture. The non-accidental injury screen was reported as negative.

An MRI scan was done to aid diagnosis. The MRI revealed the presence of bilateral subdural collections and there was T1 hyperintense linear abnormality in the posterior fossa, tent and along the falx above the cerebellum. A repeat MRI Scan six months later showed complete resolution of the subdural collections.

Conclusion: A baby presented to A&E with parents with an increasing head size (From 25th to 98th Centile) and bulging frontanelle. No associated injuries were found. The clinical examination was normal. The initial scans indicated the presence of subdural collections. However the MRI scan revealed the absence of the anterior falx cerebri when reviewed by a consultant neurosurgeon and neuroradiologist. It was deemed that these subdural collections were resolving bleeds from minor trauma associated with the absent falx cerebri. We report the first case of subdurals associated with absent falx cerebri in a child and emphasise the importance of recognising anatomical abnormalities in children to prevent unnecessary heartache for families.