Acute Subdural Hematoma and Retinal Hemorrhage Following a Witnessed Short-Distance Fall: A Case Report

Acute Subdural Hematoma and Retinal Hemorrhage Following a Witnessed Short-Distance Fall: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Acute Subdural Hematoma and Retinal Hemorrhage Following a Witnessed Short-Distance Fall: A Case Report Nobuyuki Akutsu, Hideya Hayashi, Nao Tachizawa, Junji Koyama, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9071916/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Although acute subdural hematoma (ASDH) and extensive retinal hemorrhage (RH) in infants are widely regarded as characteristic findings of abusive head trauma (AHT), they have also been reported in association with short-distance falls. We present a case of ASDH and RH following a short-distance fall in a 6-month-old infant, supported by third-party witness testimony. A 6-month-old boy rolled off a hotel bed approximately 40–50 cm in height and struck the occipital region of his head on the floor. Brain computed tomography performed on the day of injury revealed small bilateral ASDHs. Fundus examination performed 7 days after injury demonstrated bilateral RHs involving the macula, as well as hemorrhages in the peripheral retina. A police investigation found no evidence of abuse and concluded that the injuries were consistent with the reported fall. While ASDH and RH strongly warrant evaluation for AHT, rare cases may occur after short-distance falls. Comprehensive multidisciplinary assessment is essential to ensure an accurate diagnosis. abusive head trauma subdural hematoma retinal hemorrhage shaken baby syndrome short-distance falls Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Although acute subdural hematoma (ASDH) and extensive retinal hemorrhage (RH) in infants are widely regarded as characteristic findings of abusive head trauma (AHT) [ 1 – 4 ], they have also been reported in association with short-distance falls [ 5 – 10 ]. We present a case of ASDH and RH following a short-distance fall in a 6-month-old infant, supported by third-party witness testimony. Case Report A previously healthy 6-month-old boy was staying at a hotel during travel when he rolled off a hotel bed approximately 40–50 cm in height and struck the occipital region of his head on the floor. He cried immediately after the fall; however, his face subsequently became pale, and his eyes deviated upward. A hotel employee was present in the room at the time of the incident. An ambulance was called, and upon arrival, he was found to be experiencing generalized convulsions. Intravenous midazolam was administered, and the convulsions ceased. Brain computed tomography performed on the day of injury demonstrated small bilateral ASDHs (Fig. 1 ). Chest computed tomography subsequently showed findings consistent with neurogenic pulmonary edema. An intracranial pressure monitor was placed because deep sedation with neuromuscular blockade and endotracheal intubation were required. Four days after injury, electroencephalography demonstrated rhythmic activity, and brain computed tomography revealed diffuse low-density areas in both cerebral hemispheres (Fig. 2 ). The intracranial pressure monitor was removed 6 days after injury. Fundus examination performed 7 days after injury revealed bilateral RHs involving the macula and peripheral retina (Fig. 3 ). The hemorrhages gradually resolved over time. The patient was extubated 10 days after injury. A skeletal survey performed 14 days after injury revealed no fractures. Brain computed tomography performed 26 days after injury revealed cerebral atrophy and expansion of the subdural spaces (Fig. 4 ). Because of clinical deterioration, bilateral burr-hole drainage was performed. A police investigation found no evidence of abuse and concluded that the injuries were consistent with the reported fall. The patient’s condition improved postoperatively, with increased activity and improved feeding compared with his preoperative status; however, he did not regain adequate head control. He was transferred to a nearby hospital 38 days after injury. Discussion Subdural hematoma is reported in the majority of patients with AHT, and in infants, it is most commonly associated with abuse [ 1 ]. In addition, bilateral and extensive RHs involving both the posterior pole and the peripheral retina are widely regarded as characteristic findings of AHT [ 2 , 3 ]. Therefore, infants presenting with ASDH and/or RH following short-distance falls should undergo thorough evaluation for possible AHT. However, according to the American Academy of Pediatrics, the occurrence of ASDH and RH following short-distance falls cannot be completely excluded [ 4 ]. Since the early 2000s, an increasing number of reports have described ASDH and RH in infants after short-distance falls [ 5 – 10 ]. Brook et al. [ 11 ] reported a case of an 8-month-old infant in whom a video-recorded 26-cm fall resulted in ASDH and extensive RH. Although such cases appear to be uncommon, this report demonstrates that ASDH and RH may occur even after very short-distance falls. Akutsu et al. [ 12 ] reported that among 158 patients younger than 4 years with subdural hematoma in Japan, 51 were classified as having non-accidental injuries and 107 as having accidental injuries. Similarly, Högberg et al. [ 13 ] reported that among 306 infants younger than 1 year with subdural hematoma in Sweden, 104 (34.0%) were classified as having sustained injuries due to accidental falls. Thus, while the presence of ASDH and extensive RH strongly raises concern for AHT, accidental mechanisms cannot be completely excluded in all cases. A skeletal survey is recommended in children younger than 2 years when there are concerns regarding physical abuse [ 14 ]. Careful evaluation of the clinical history, consistency of the reported mechanism, witness accounts, and multidisciplinary assessment is essential when determining the cause of injury. It should be noted that the definition of “short-distance falls” varies across studies, and the exact height and surface conditions are not always described uniformly. In addition, published reports may be subject to reporting bias because unusual or severe cases following minor trauma are more likely to be documented. Furthermore, the reliability of witness accounts can vary, and inconsistencies in the reported mechanism should raise concern. Therefore, each case must be evaluated individually, with careful consideration of the injury pattern, clinical course, radiologic findings, social background, and consistency of the history. A comprehensive, multidisciplinary approach remains essential to avoid both missed diagnoses of abuse and inappropriate attribution of injury to abusive mechanisms. Conclusion While ASDH and RH strongly warrant evaluation for AHT, rare cases may occur after short-distance falls. Comprehensive multidisciplinary assessment is essential to ensure an accurate diagnosis. Declarations Acknowledgment We thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac), for editing a draft of this manuscript. Author contributions All authors contributed to the study conception and design. The first draft of the manuscript was written by Nobuyuki Akutsu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding No funding was received for this work. Data availability No datasets were generated or analyzed during the current study. Consent to participate Informed consent was obtained from the patient’s parent. Competing interests The authors declare no competing interests. Ethics approval All procedures performed in this case report were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. References Matschke J, Voss J, Obi N, Görndt J, Sperhake JP, Püschel K, Glatzel M (2009) Nonaccidental head injury is the most common cause of subdural bleeding in infants < 1 year of age. Pediatrics 124:1587–1594. https://doi.org/10.1542/peds.2008-3734 Binenbaum G, Mirza-George N, Christian CW, Forbes BJ (2009) Odds of abuse associated with retinal hemorrhages in children suspected of child abuse. J AAPOS. https://doi.org/10.1016/j.jaapos.2009.03.005 . 13:268 – 72 Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, Mann MK, Tempest V, Kemp AM (2013) Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review. Eye (Lond) 27:28–36. https://doi.org/10.1038/eye.2012.213 Narang SK, Haney S, Duhaime AC, Martin J, Binenbaum G, de Alba Campomanes AG, Barth R, Bertocci G, Care M, McGuone D, COUNCIL ON CHILD ABUSE AND NEGLECT; SECTION ON OPHTHALMOLOGY; SECTION ON RADIOLOGY; SECTION ON NEUROLOGICAL SURGERY; SOCIETY FOR PEDIATRIC RADIOLOGY; AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS; AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS; AMERICAN ACADEMY OF OPHTHALMOLOGY (2025) Abusive Head Trauma in Infants and Children: Technical Report. Pediatrics. 155:e2024070457. https://doi.org/10.1542/peds.2024-070457 Aoki N (2024) Clinical and neuroimaging characteristics in mild-type infantile acute subdural hematoma: report of four cases. Childs Nerv Syst 40:189–195. https://doi.org/10.1007/s00381-023-06089-7 Atkinson N, van Rijn RR, Starling SP (2018) Childhood Falls With Occipital Impacts. Pediatr Emerg Care 34:837–841. https://doi.org/10.1097/PEC.0000000000001186 Denton S, Mileusnic D (2003) Delayed sudden death in an infant following an accidental fall: a case report with review of the literature. Am J Forensic Med Pathol 24:371–376. https://doi.org/10.1097/01.paf.0000097851.18478.16 Fung EL, Sung RY, Nelson EA, Poon WS (2002) Unexplained subdural hematoma in young children: is it always child abuse? Pediatr Int 44:37–42. https://doi.org/10.1046/j.1442-200x.2002.01500.x Gardner HB (2007) A witnessed short fall mimicking presumed shaken baby syndrome (inflicted childhood neurotrauma). Pediatr Neurosurg 43:433–435. https://doi.org/10.1159/000106399 Plunkett J (2001) Fatal pediatric head injuries caused by short-distance falls. Am J Forensic Med Pathol 22:1–12. https://doi.org/10.1097/00000433-200103000-00001 Brook C, Squier W, Mack J (2024) 26 cm fall caught on video causing subdural hemorrhages and extensive retinal hemorrhages in an 8-month-old infant. Clin Case Rep 12:e9105. https://doi.org/10.1002/ccr3.9105 Akutsu N, Nonaka M, Narisawa A, Kato M, Harada A, Park YS (2022) Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group. PLoS ONE 17:e0264396. https://doi.org/10.1371/journal.pone.0264396 Högberg U, Andersson J, Squier W, Högberg G, Fellman V, Thiblin I, Wester K (2018) Epidemiology of subdural haemorrhage during infancy: A population-based register study. PLoS ONE 13:e0206340. https://doi.org/10.1371/journal.pone.0206340 Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics (2015) The evaluation of suspected child physical abuse. Pediatrics 135:e1337–e1354. https://doi.org/10.1542/peds.2015-0356 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9071916","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":625123353,"identity":"c820db14-71b5-406f-a457-cd2c880ecadb","order_by":0,"name":"Nobuyuki 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demonstrating bilateral acute subdural hematomas\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9071916/v1/8f46a737613eb4547df28c3d.png"},{"id":107377650,"identity":"83b4ec94-442c-4edc-a432-b305f3ea7f6b","added_by":"auto","created_at":"2026-04-21 01:30:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1163738,"visible":true,"origin":"","legend":"\u003cp\u003eBrain computed tomography demonstrating diffuse low-density areas in both cerebral hemispheres\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9071916/v1/dcac999403425ccc1f489e06.png"},{"id":107377651,"identity":"069038f5-9874-4b05-abcb-6cc9d4ae11fc","added_by":"auto","created_at":"2026-04-21 01:30:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":460388,"visible":true,"origin":"","legend":"\u003cp\u003eFundus photograph demonstrating bilateral retinal hemorrhages involving the macula, as well as hemorrhages in the peripheral retina\u003c/p\u003e","description":"","filename":"figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9071916/v1/76865d90a82899ab1d773ee1.png"},{"id":107377655,"identity":"e040f93b-c00d-4bde-8cf9-816a063f34ee","added_by":"auto","created_at":"2026-04-21 01:30:58","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":288902,"visible":true,"origin":"","legend":"\u003cp\u003eBrain computed tomography demonstrating cerebral atrophy and bilateral enlargement of the subdural spaces\u003c/p\u003e","description":"","filename":"figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-9071916/v1/ee8d5eb1acfdbca408695d94.png"},{"id":107775240,"identity":"46329249-92e1-4627-9cde-44b2bc953ea3","added_by":"auto","created_at":"2026-04-25 06:40:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3431805,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9071916/v1/a65242f8-1b66-486f-8a5d-fec7c58097a0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Acute Subdural Hematoma and Retinal Hemorrhage Following a Witnessed Short-Distance Fall: A Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAlthough acute subdural hematoma (ASDH) and extensive retinal hemorrhage (RH) in infants are widely regarded as characteristic findings of abusive head trauma (AHT) [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], they have also been reported in association with short-distance falls [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. We present a case of ASDH and RH following a short-distance fall in a 6-month-old infant, supported by third-party witness testimony.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA previously healthy 6-month-old boy was staying at a hotel during travel when he rolled off a hotel bed approximately 40\u0026ndash;50 cm in height and struck the occipital region of his head on the floor. He cried immediately after the fall; however, his face subsequently became pale, and his eyes deviated upward. A hotel employee was present in the room at the time of the incident. An ambulance was called, and upon arrival, he was found to be experiencing generalized convulsions. Intravenous midazolam was administered, and the convulsions ceased. Brain computed tomography performed on the day of injury demonstrated small bilateral ASDHs (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Chest computed tomography subsequently showed findings consistent with neurogenic pulmonary edema. An intracranial pressure monitor was placed because deep sedation with neuromuscular blockade and endotracheal intubation were required.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFour days after injury, electroencephalography demonstrated rhythmic activity, and brain computed tomography revealed diffuse low-density areas in both cerebral hemispheres (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The intracranial pressure monitor was removed 6 days after injury. Fundus examination performed 7 days after injury revealed bilateral RHs involving the macula and peripheral retina (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The hemorrhages gradually resolved over time. The patient was extubated 10 days after injury. A skeletal survey performed 14 days after injury revealed no fractures. Brain computed tomography performed 26 days after injury revealed cerebral atrophy and expansion of the subdural spaces (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Because of clinical deterioration, bilateral burr-hole drainage was performed.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA police investigation found no evidence of abuse and concluded that the injuries were consistent with the reported fall. The patient\u0026rsquo;s condition improved postoperatively, with increased activity and improved feeding compared with his preoperative status; however, he did not regain adequate head control. He was transferred to a nearby hospital 38 days after injury.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSubdural hematoma is reported in the majority of patients with AHT, and in infants, it is most commonly associated with abuse [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In addition, bilateral and extensive RHs involving both the posterior pole and the peripheral retina are widely regarded as characteristic findings of AHT [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, infants presenting with ASDH and/or RH following short-distance falls should undergo thorough evaluation for possible AHT.\u003c/p\u003e \u003cp\u003eHowever, according to the American Academy of Pediatrics, the occurrence of ASDH and RH following short-distance falls cannot be completely excluded [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Since the early 2000s, an increasing number of reports have described ASDH and RH in infants after short-distance falls [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Brook et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] reported a case of an 8-month-old infant in whom a video-recorded 26-cm fall resulted in ASDH and extensive RH. Although such cases appear to be uncommon, this report demonstrates that ASDH and RH may occur even after very short-distance falls.\u003c/p\u003e \u003cp\u003eAkutsu et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] reported that among 158 patients younger than 4 years with subdural hematoma in Japan, 51 were classified as having non-accidental injuries and 107 as having accidental injuries. Similarly, H\u0026ouml;gberg et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] reported that among 306 infants younger than 1 year with subdural hematoma in Sweden, 104 (34.0%) were classified as having sustained injuries due to accidental falls. Thus, while the presence of ASDH and extensive RH strongly raises concern for AHT, accidental mechanisms cannot be completely excluded in all cases. A skeletal survey is recommended in children younger than 2 years when there are concerns regarding physical abuse [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Careful evaluation of the clinical history, consistency of the reported mechanism, witness accounts, and multidisciplinary assessment is essential when determining the cause of injury.\u003c/p\u003e \u003cp\u003eIt should be noted that the definition of \u0026ldquo;short-distance falls\u0026rdquo; varies across studies, and the exact height and surface conditions are not always described uniformly. In addition, published reports may be subject to reporting bias because unusual or severe cases following minor trauma are more likely to be documented. Furthermore, the reliability of witness accounts can vary, and inconsistencies in the reported mechanism should raise concern. Therefore, each case must be evaluated individually, with careful consideration of the injury pattern, clinical course, radiologic findings, social background, and consistency of the history. A comprehensive, multidisciplinary approach remains essential to avoid both missed diagnoses of abuse and inappropriate attribution of injury to abusive mechanisms.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhile ASDH and RH strongly warrant evaluation for AHT, rare cases may occur after short-distance falls. Comprehensive multidisciplinary assessment is essential to ensure an accurate diagnosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e We thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac), for editing a draft of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e All authors contributed to the study conception and design. The first draft of the manuscript was written by Nobuyuki Akutsu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e No funding was received for this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e No datasets were generated or analyzed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e Informed consent was obtained from the patient\u0026rsquo;s parent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e All procedures performed in this case report were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMatschke J, Voss J, Obi N, G\u0026ouml;rndt J, Sperhake JP, P\u0026uuml;schel K, Glatzel M (2009) Nonaccidental head injury is the most common cause of subdural bleeding in infants\u0026thinsp;\u0026lt;\u0026thinsp;1 year of age. Pediatrics 124:1587\u0026ndash;1594. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2008-3734\u003c/span\u003e\u003cspan address=\"10.1542/peds.2008-3734\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBinenbaum G, Mirza-George N, Christian CW, Forbes BJ (2009) Odds of abuse associated with retinal hemorrhages in children suspected of child abuse. J AAPOS. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jaapos.2009.03.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jaapos.2009.03.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 13:268\u0026thinsp;\u0026ndash;\u0026thinsp;72\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, Mann MK, Tempest V, Kemp AM (2013) Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review. 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Pediatrics 135:e1337\u0026ndash;e1354. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2015-0356\u003c/span\u003e\u003cspan address=\"10.1542/peds.2015-0356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"abusive head trauma, subdural hematoma, retinal hemorrhage, shaken baby syndrome, short-distance falls","lastPublishedDoi":"10.21203/rs.3.rs-9071916/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9071916/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAlthough acute subdural hematoma (ASDH) and extensive retinal hemorrhage (RH) in infants are widely regarded as characteristic findings of abusive head trauma (AHT), they have also been reported in association with short-distance falls. We present a case of ASDH and RH following a short-distance fall in a 6-month-old infant, supported by third-party witness testimony. A 6-month-old boy rolled off a hotel bed approximately 40\u0026ndash;50 cm in height and struck the occipital region of his head on the floor. Brain computed tomography performed on the day of injury revealed small bilateral ASDHs. Fundus examination performed 7 days after injury demonstrated bilateral RHs involving the macula, as well as hemorrhages in the peripheral retina. A police investigation found no evidence of abuse and concluded that the injuries were consistent with the reported fall. While ASDH and RH strongly warrant evaluation for AHT, rare cases may occur after short-distance falls. Comprehensive multidisciplinary assessment is essential to ensure an accurate diagnosis.\u003c/p\u003e","manuscriptTitle":"Acute Subdural Hematoma and Retinal Hemorrhage Following a Witnessed Short-Distance Fall: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-21 01:30:54","doi":"10.21203/rs.3.rs-9071916/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"44f51cdb-8c62-4cd5-84da-dab935eae8d5","owner":[],"postedDate":"April 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-25T06:39:04+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-21 01:30:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9071916","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9071916","identity":"rs-9071916","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}