Benign enlargement of the subarachnoid space in infancy

Discussion:

The following is important in the diagnosis of benign enlargement of the subarachnoid space (BESS) in infancy:

  1. It may be complicated by subdural hemorrhage that is explained by the stretching of the stretching of the bridging subdural veins due to enlargement of the cerebrospinal fluid (CSF) spaces.
  2. The presence of subdural hemorrhage in children <2 years of age raises two distinct possibilities - non-accidental injury (NAI) and BESS. For medico-legal reasons, the distinction between both of them is important. The absence of other features of, such as bone fractures and cerebral injuries, favors the diagnosis of BESS rather than NAI.
  3. There is a normal development, although delayed milestones may be encountered.
  4. Usually resolves spontaneously by 2 years of age.
  5. The cause makes the subarachnoid spaces enlarged in these children is the delayed maturation of the arachnoid villi.
  6. BESS may present with macrocephaly.
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