Abstract 3- 0930-0945
Category: Clinical

At the end of the session,
participants will be able to:

  1. Describe the normal anatomical connections between the intracranial and spinal subdural and subarachnoid compartments.

  2. Describe hemorrhagic lesions following trauma to the neonatal, infant, and pediatric brain and spinal cord.

COI Disclosure:

None to disclose


Marc Del Bigio
Professor – Department of Pathology, University of Manitoba
MD 1982 PhD 1987
Neuropathologist since 1994 (residency University of Toronto)


Marc R. Del Bigio

Department of Pathology, University of Manitoba and Diagnostic Services Manitoba, Winnipeg MB Canada

Target Audience:
Pathologists, Residents, Medical Students

Medical Expert (the integrating role), Scholar

Spinal nerve root blood in pediatric autopsy cases is not necessarily a marker of trauma at that site


Increasingly, the forensic examination of suspected child abuse cases includes dissection of the entire cervical spine; hemorrhage along nerve roots is postulated to indicate forces exerted by shaking. Seventy pediatric spinal cords encased in dura mater were examined (including 12 en bloc cervical spines); age 0-58 months. The mechanism of deaths were: suspected abusive trauma 35; accident 13; undetermined or natural without head/neck trauma 12; forceps injury at birth 3; birth related intracranial hemorrhage 7. Prominent spinal subarachnoid hemorrhage was present in 30 cases; hemorrhage was detected along spinal nerve roots at the cervical level in 14/30 and at the lumbosacral level in 8/30 in the absence of definite injury to the spinal column. Two cases with definite evidence of bone/ligamentous injury to the spine and the 2 forceps injury cases had extensive epidural hemorrhage ± subarachnoid hemorrhage extending the entire length of the cord. Anatomical studies in humans, tracer studies, and experimental hemorrhage show direct communication of the cranial and spinal subarachnoid and subdural spaces with extension to the dorsal root ganglia. I conclude that the majority of spinal nerve root hemorrhages in pediatric trauma cases are simply markers of subarachnoid or subdural hemorrhage elsewhere. Additional work is needed to determine if en bloc spine dissection, which is invasive and time consuming, adds significant information to the autopsy.