Acute subdural haematoma in sudden infant death: diagnostic challenges in a low-resource setting;non-accidental injury,post-mortem or resuscitation artefact?

Abstract

Acute subdural haemorrhage in sudden infant death (SID) presents a forensic challenge, particularly in resource-limited settings, where distinguishing true injury from resuscitation or post-mortem artefacts is difficult. We report a case of a previously healthy 2-month-old male infant found unresponsive shortly after being placed prone following breastfeeding. Despite prolonged resuscitation, the infant died. Autopsy revealed faint anterior chest contusions consistent with resuscitation and bilateral acute subdural haemorrhages without skull fractures, retinal haemorrhages or cerebral oedema. Histology confirmed acute subdural and subarachnoid haemorrhages without chronic changes, and toxicology was negative. Scene investigation identified no risk factors for trauma or accidental suffocation. The findings suggest the haemorrhages probably resulted from peri-mortem hypoxic vascular injury or resuscitation artefacts, emphasising the importance of integrating clinical history, autopsy, histology and scene information to avoid misinterpretation of subdural haemorrhages in cases of SID.