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IntroductionWhen infants present with subdural collections, inflicted head trauma is invariably considered. However, studies in children with subdural collections associated with enlargement of the subarachnoid spaces indicate that they can be an incidental finding, arising spontaneously or with minor, non-inflicted trauma.ObjectivesTo determinethe frequency of subdural haemorrhage with enlargement of the subarachnoid spaces andany characteristic clinical or neuroimaging pattern for such haemorrhages that might distinguish an incidental finding from an inflicted injury.DesignSystematic reviewSettingLiterature search of databases for English-language articles, conference abstracts and references. Articles had 2 independent reviewers (3 if disputed) and critical appraisal.PatientsChildren under 2-years-of-age with subdural haemorrhage (SDH) in association with benign enlargement of the subarachnoid spaces (BESS).Main Outcome MeasuresClinical and neurological features that differentiate inflicted from non-inflicted head trauma.Results21 studies were analysed. SDH were found in 7.1% (95% CI 3.05 – 11.15) of infants with BESS. The mean age was 7.2 months. The characteristic pattern of SDH found were isolated frontal, or bifrontal collections of varying ages, and without parenchymal involvement, associated with macrocephaly or rapidly increasing head circumference, found incidentally or with irritability, or seizures. Apnoea or acute collapse was uncommon. Retinal haemorrhages were found in 11% but not described in detail with the exception of one case report. In those infants investigated for possible inflicted head trauma, 7.6% were confirmed.ConclusionIn infants with an isolated or bifrontal SDH found incidentally or with symptoms such as irritability, in association with macrocephaly and BESS, and without parenchymal involvement and stigmata associated with maltreatment, inflicted head injury may not require exclusion, but this decision must be taken on a case-by-case basis. The exception would be the presence of retinal haemorrhages.