NCJ Number
183888
Journal
Journal of Forensic Sciences Volume: 44 Issue: 6 Dated: November 1999 Pages: 1114-1118
Date Published
November 1999
Length
5 pages
Annotation
Several researchers in the 1950's proposed that hypernatremia causes water to leave brain cells, thus shrinking the brain and tearing the bridging veins, resulting in subdural hematomas. To re-examine the issue of hypernatremia and subdural hematoma in the context of current medical knowledge and availability of neuroradiologic imaging techniques, the authors conducted a multifaceted investigation of the issue.
Abstract
This issue is important for forensic pathologists who must distinguish natural disease from trauma. The current investigation included a small retrospective review of autopsy findings in deceased children with elevated vitreous sodium values; a larger retrospective chart review of hospitalized hypernatremic children; a complementary retrospective chart review of hospitalized children with subdural hemorrhages; a review of cases of fatal head injury with hospitalized survival intervals and post-injury hypernatremia; a critical review of the literature; and a review of recent anecdotal cases of severe hypernatremia. Contrary to the older literature, which theorized a causal relationship between hypernatremia and subdural hematomas, this study could not identify a cause-and-effect relationship between hypernatremia and the subsequent development of subdural hematoma. If there is a cause-and-effect relationship, this study's data suggest that it must be extremely rare. The authors thus conclude that hypernatremia may occur as one of myriad complications that can arise in critically ill children, with or without intracranial pathology. 3 tables and 23 references