Das Ziel dieser Studie war die Analyse der Ergebnisse der mikrochirurgischen Therapie von Akustikusneurinomen (AN) über den transtemporalen Zugangsweg unter Einsatz eines flexiblen CO2-Faserlasers (Omniguide®). Zu diesem Zweck wurde eine prospektive nicht randomisierte klinische Studie durchgeführt. Bei 20 aufeinander folgenden Patienten, bei denen eine mikrochirurgische Exstirpation des Tumors über den transtemporalen Zugangsweg erfolgte, wurde die Tumorresektion mit Hilfe des flexiblen CO2-Lasers durchgeführt (Lasergruppe, LG). Als Vergleichsgruppe wurden 20 Patienten mit vergleichbarer Tumorgröße und gleichem präoperativen Hörvermögen aus einer Kohorte von 76 Patienten ausgewählt (matched pairs), die zu einem früheren Zeitpunkt vom selben Operateur ohne Zuhilfenahme des Lasers operiert worden waren (Kontrollgruppe, KG). In der frühen postoperativen Phase konnte bei jeweils sechs Patienten beider Gruppen eine Facialisschwäche nach House-Brackmann (HB) Grad 2-4 festgestellt werden. Nach drei Monaten zeigte sich lediglich bei einem Patienten der KG noch eine leichte Facialisschwäche (HB-Grad 2). Der Erhalt der Facialisfunktion (HB-Grad 1 und 2) lag bei beiden Gruppen bei 100 %. Der Hörerhalt (Gardner-Robertson-Klasse 1 und 2 prä- und postoperativ) lag in der LG bei 72 % und in der KG bei 82 % ohne statistisch signifikanten Unterschied. Die absolute Operationszeit (Schnitt-Naht-Zeit) betrug in der KG 157 min und in der LG 160 min. Die Präparationszeit des Tumors lag in der KG bei 23,2 min und bei der LG bei 36,1 min. Durch den Einsatz des CO2-Lasers konnte zwar keine Reduktion der Operationszeit erreicht werden, jedoch zeigten sich im Vergleich zur konventionellen Technik postoperativ die gleichen guten funktionellen Ergebnisse, so dass der CO2-Laser eine sinnvolle Ergänzung für spezielle Fälle sein kann (z.B. bei stark vaskularisierten Tumoren). / The aim of this study was to analyze the results of microsurgery in vestibular schwannomas (VS) with assistance of a flexible CO(2) laser fiber (Omniguide(®)) using the middle cranial fossa (MCF) approach. For that purpose we performed a prospective non-randomized clinical trial. In 20 consecutive patients suffering from VS and elected for microsurgery via the MCF approach, tumor resection was performed with the aid of the flexible CO(2) laser ("laser group", LG). Twenty patients with similar tumor volume and pre-operative hearing status out of a cohort of 76 patients previously treated by the same surgeon without laser were used as comparison group ("conventional group", CG) (matched-pair-technique). Facial weakness (House-Brackmann (HB) 2-4) was seen in early postoperative (p.o.) days in six patients in each group and all recovered completely by 3 months p.o., except one patient with HB 2 in CG. Facial nerve preservation rate (HB 1 + 2) was 100% in both groups. Hearing preservation rate (Gardner/Robertson class 1 + 2 or AAO-HNS A + B, pre- and postoperatively) was 72% in LG and 82% in CG, without significant difference. Overall time from incision to skin suture was 157 min (SD 55.9) in CG and 160 min (SD 39.7) in LG. Tumor preparation time was 23.2 min (SD 19.7) in CG and 36.1 min (SD 33.8) in LG. The use of a handheld flexible CO(2) laser fiber in VS-microsurgery is safe and subjectively facilitates tumor resection especially in "difficult" (e.g., highly vascularized) tumors. However, in this limited prospective trial the excellent functional outcome following conventional microsurgery could not be further improved, nor the surgical time reduced by means of the non-contact laser-tool. Focusing the use of the flexible CO(2) laser on "difficult" tumors may lead to different results in future.

Today, groups considered Hispanic in the United States consist of populations whose complex genetic structures reflect intermixed diverse groups of people who came in contact during Spanish colonization in Latin America. After coming in contact and wiping out most of the Native Americans who occupied North and Latin America, the Spanish also introduced West African individuals for labor to begin developing crops to be shipped back to Europe, resulting in the Trans-Atlantic African slave trade. These migration events and differential gene flow among males and females that occurred throughout Latin America have led to populations that have been genetically transformed from what they were prior to Spanish arrival (Madrigal, 2006). Genetic research commonly refers to individuals considered Hispanic as "tri-hybrids" of Native American, European, and African ancestry (Bertoni et al., 2003; Gonz[aacute]lez-Andrade et al., 2007). This research focuses on populations from present-day Mexico, Puerto Rico, and Cuba, all of whom experienced various population histories as these three ancestral groups came in contact. Published genetic research demonstrates that individuals from Mexico tend to have the highest mean proportion of Native American ancestry, while Puerto Rican individuals have the highest mean proportion of European ancestry, and Cuban individuals have the highest mean proportion of African ancestry (Bonilla et al., 2005; Lisker et al., 1990; Mendizabal et al., 2008; Tang et al., 2007; Via et al., 2011). The present research utilizes craniometric data from these three groups to determine whether the cranial morphology reflects similar population relationships and mean ancestry proportions as found in genetic research through Mahalanobis distance (D2), canonical discriminant function, and normal mixture cluster analyses. Sex-biased ancestry asymmetry was also tested by separating each group by sex and running the same analyses. The results show that all three groups considered Hispanic (Mexico, Puerto Rico, and Cuba) are significantly different from each other; however, when proxy ancestral groups are included (Guatemalan Mayan, Indigenous Caribbean, Spanish, and West African), the Mexican and Guatemalan Mayan samples are the most similar, followed by the Mexican and Indigenous Caribbean samples and the Puerto Rican and Cuban samples. The results of the normal mixture analyses indicate that Mexico has the highest mean ancestry proportion of Native American (Guatemalan Mayan) (72.9%), while the Puerto Rican and Cuban samples both have a higher mean European ancestry proportion, with 81.34% and 73.6% respectively. While the Cuban sample is not reflective of the genetic research in regards to ancestry proportion results, with the highest proportion of African ancestry over European and Native American ancestry, it does have the highest proportion of African ancestry among the three groups (18.4%). When separated by sex, the results indicate that the Mexican and Puerto Rican samples may show some evidence in sex-biased ancestry proportions, with the male individuals having a larger proportion of European ancestry and the female individuals having a larger proportion of Native American or African ancestry. Cuba, on the other hand, does not follow this trend and instead displays a higher proportion of European ancestry in females and a higher proportion of Native American and African ancestry in the males. Techniques in the field of forensic anthropology in the United States are constantly being reanalyzed and restructured based on the changing demographics of the population, especially with the arrival of individuals from Latin America (Ennis et al., 2011). Recent samples of American Black and White individuals were included in the Mahalanobis distance (D2) and canonical discriminant function analyses in place of the ancestral proxy groups to determine the craniometric relationship of the groups within the United States. The results show that the Mexico and Guatemala samples are the most similar (D2=2.624), followed by the Cuba and American Black samples (D2=3.296) and the Puerto Rico and American White samples (D2=4.317), which each cluster together in pairs. These results reflect the population histories that took place during colonialism, with the largest amount of slave trade occurring in Cuba over the other two countries. From an applied perspective, clarification is needed in the biological definition of Hispanic and the degree of heterogeneity in each social group, as well as the relationship among groups, in order to accurately develop techniques in forensic anthropology for human identification.

This thesis is the final outcome of the project "Quantitative genetics of craniofacial traits: a functional approach to heritability", which received support from the Wenner-Gren Foundation for Anthropological Research in 2004.The main goal is to integrate geometric morphometric with quantitative genetics in order to estimate the genetic variation underlying skull morphology and to assess its capability to evolve. The analyses herein are based on a sample of human skulls from Hallstatt, an Austrian village from the Alps. The uniqueness of this sample for evolutionary anthropological studies is the availability of associated genealogical data.The results show that substantial amounts of genetic variation underlying both size and shape and pervasive genetic integration are the two main aspects that characterize the genetic architecture of the human skull. The main developmental regions of the human skull (namely the face, the neurocranium and the basicranium) have similar amounts of genetic variation. There is evidence for genetic constraints, which reduce the evolutionary potential of the human skull. These correspond to shape features that can not evolve because they do not have sufficient genetic variation. The ability to evolve is restricted by complex patterns of covariation among cranial regions which direct evolution towards certain trajectories of morphological change that would maintain an operational and functional skull shape.Simulation analyses suggest a re-interpretation of the selective scenarios for human evolution. The origin of any one of the derived characters of modern humans may have facilitated the evolution of the others. The morphological changes associated with bipedalism may have enhanced the evolution of a more globular and expanded neurocranial shape, which could be favoured afterwards by selection for bigger and more complex brains. Natural selection has significantly acted over the last 200 years, since strong directional selection on skull shape and weak stabilizing selection on skull size has been detected at Hallstatt's population. However, other microevolutionary forces contributed to the evolution of skull morphology but in opposite directions, causing a non correspondence between secular trends and the response to selection patterns. The skull responds to these pressures through complex and widespread networks of genetic and epigenetic interactions. / Aquesta tesi és el resultat final d'un projecte titulat "Quantitative genetics of craniofacial traits: a functional approach to heritability", que va rebre finançament per part de la Wenner Gren Foundation for Anthropological Research l'any 2004. El principal objectiu d'aquest projecte és integrar els mètodes de Morfometria Geomètrica i de Genètica Quantitativa per quantificar la variació genètica que determina la morfologia del crani humà i estimar la seva capacitat d'evolucionar. Les anàlisis realitzades estan basades en una mostra de cranis moderns de Hallstatt, una localitat dels Alps austríacs. Aquesta és una mostra única per a estudis d'antropologia evolutiva perquè els cranis tenen informació demogràfica i genealògica associada. Altres objectius específics de la tesi es detallen a continuació: 1) Quantificar els patrons de variació-covariació genètica, fenotípica i ambiental de la morfologia craniofacial humana, a través de caràcters craneomètrics univariats i multivariats. 2) Analitzar els patrons d'integració morfològica del crani humà, tant a nivell fenotípic com genètic. 3) Estimar la capacitat evolutiva del crani humà. 4) Simular l'evolució dels caràcters derivats de la morfologia craniofacial dels humans moderns.5) Detectar l'acció de la selecció natural en el crani humà, combinant dades demogràfiques d'èxit reproductiu amb dades morfològiques. Els resultats obtinguts evidencien que els dos aspectes que caracteritzen l'arquitectura genètica del crani humà són, d'una banda, els elevats nivells de variació genètica que determinen tant la forma com la grandària del crani humà; i per l'altra, els patrons dominants d'integració morfològica. Les tres regions principals del crani (la cara, el neurocrani i el basicrani) presenten nivells similars de variació genètica, però la base del crani és la que mostra una major integració. Les anàlisis de Genètica Quantitativa indiquen l'existència de límits genètics al canvi morfològic, que redueixen la capacitat de resposta a la selecció. Aquests límits corresponen a característiques morfològiques que no poden evolucionar perquè no tenen suficient variació genètica heretable. La capacitat evolutiva del crani humana està restringida i dirigida cap a determinades trajectòries de canvi morfològic que mantindrien una forma cranial operativa i funcional. Les anàlisis de simulació de la selecció mostren que l'origen de qualsevol dels caràcters derivats dels humans moderns pot haver facilitat l'evolució dels altres, fet que suggereix una reinterpretació dels escenaris selectius de l'evolució humana. Concretament, els resultats indiquen que l'evolució del bipedisme podria haver estimulat l'evolució d'una volta cranial més gran i més globular, que posteriorment podria haver estat afavorida per la selecció per un cervell de major grandària i més complex, tal com indiquen les evidències moleculars. Finalment, s'ha detectat que la selecció natural ha operat en l'evolució de la forma del crani de la població de Hallstatt durant els últims 200 anys. Els resultats mostren una acció significativa de selecció direccional en la forma del crani i de selecció estabilitzadora en la grandària del crani. No obstant això, es detecta que altres forces microevolutives (flux gènic, mestissatge, variació ambiental) han participat en aquest procés evolutiu, però en direccions oposades a les seleccionades. La conclusió general d'aquesta tesi posa de manifest que el crani humà es troba sota l'acció de nombroses forces evolutives, que actuen simultàniament i dirigint el canvi morfològic. El crani respon a aquestes pressions a través de complexes xarxes d'interacció genètica i epigenètica.

Abstract MtDNA D-loop sequences and cranial morphometrics were used to analyze the phylogenetic relationships of bharal (Pseudois nayaur szechuanensis) populations. The habitat preferences of bharal were also investigated in Helanshan, Ningxia. The results from the analysis of mtDNA D-loop sequences and cranial morphometrics were in accordance. Among all populations analyzed, the phylogenetic relationships between populations in Lixian, Sichuan and Helanshan, Ningxia were most distantly related, while populations in Dulan, Qinghai and Subei, Gansu were close to one another. No matter in summer or winter, bharal generally prefer to stay in meadows, but they would appear in forests and shrubs as well.

Craniosynostosis is the premature fusion of one or more cranial sutures in the developing skull. If left untreated, craniosynostosis can result in developmental delays, blindness, deafness, and other impairments resulting from an increase in the intracranial pressure. In many cases, the treatment consists of complex calvarial vault reconstruction with the hope of restoring a normal skull appearance and volume. Re-synostosis, the premature re-closure following surgery, occurs in up to 40% children who undergo surgery. If this occurs, a second surgery is needed to remove portions of the fused skull in an attempt to correct the deformities and/or relieve an increase in intracranial pressure. These subsequent surgeries are associated with an incredibly high incidence of life threatening complications. To address this unmet clinical need we have developed strategies to delay the post-operative bone growth in a clinically relevant murine model of re-synostosis. The overall objective of this thesis was to develop a hydrogel based therapy to delay rapid bone regeneration in a murine model of re-synostosis. The overall hypothesis was that delivery of key BMP inhibitors involved in regulating normal suture development and regeneration will delay the rapid bone growth that in seen in a pediatric murine model of re-synostosis. The overall approach is to use micro-computed tomography (µCT) to determine the time course of suture fusion and to identify genes associated with key developmental time points, to develop a pediatric specific mouse model that displays rapid re-synostosis, and lastly to develop a hydrogel based therapy to delay the re-synostosis of this cranial defect.

Extant monotremes have a combination of plesiomorphic and apomorphic characters that causes ambiguity about their basic anatomy and evolutionary history. The problem is compounded by the lack of extinct and extant specimens of monotremes available for study. Only five species of monotremes are currently recognized, and all are endangered. The most speciose subclade, the long-beaked echidna, Zaglossus, has few specimens archived in mammalogy collections relative to the platypus, Ornithorhynchus anatinus, and the short-beaked echidna, Tachyglossus aculeatus. As a result, researchers sample from Ornithorhynchus and Tachyglossus, excluding species of Zaglossus from analysis. An equally depauperate fossil record consisting primarily of fragmentary jaws and isolated molars over a broad temporal range (~125 Ma) has led to controversies surrounding the origin and evolution of Monotremata and its major subclades. As new fossils attributable to Monotremata have been discovered, they are placed in conflicting positions on either the crown or the stem. I used CT scans of skeletally immature and mature specimens of Zaglossus bruijni and Zaglossus bartoni, respectively, to describe the cranial osteology of Zaglossus in detail. New insights about the anatomy of Zaglossus were then utilized in a phylogenetic analysis. Zaglossus and the extinct echidna, Megalibgwilia were added to a previously published morphological character matrix, along with 42 new skeletal characters. For the first time, I illustrated the cranial anatomy of Zaglossus bruijnii and Zaglossus bartoni, and described the endocranial morphology and individual variation among the two species. I described patterns of ossification throughout ontogeny that may explain a preservation bias against echidnas. My phylogenetic analysis placed the Early Cretaceous monotremes either on the stem of Ornithorhynchidae or in the monotreme crown, supporting an Early Cretaceous divergence estimate between platypuses and echidnas. I provide the first phylogenetic definition and diagnosis of Monotremata, Ornithorhynchidae, and Tachyglossidae. Based on the distribution of characters of extant monotremes, the ancestral monotreme was likely a terrestrial, scratch-digger capable of electroreception. The ancestral population gave rise to the semi-aquatic platypuses and the large, terrestrial echidnas. Tachyglossus is the most derived of the extant echidnas; it is more appropriate to include Ornithorhynchus and Zaglossus in future phylogenetic analyses. / text

No description available.

Background: Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation. Materials and methods: Branching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections. Results: Cervical vagus nerve branching was observed in 29%of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79mm vs. 3.78mm) and cross-sections (7.24 mm2 vs. 5.28mm2). Discussion: Cervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation.

Following a head concussion the intracranial pressure increases due to the impact, which cannot be adequately relieved because of the stiffness of the skull. Popular strategies aimed at decompressing the head consist in the administration of osmotic agents and skull removal. The mechanical properties of bone can be affected by the administration of different solutions. If the malleability of skull is influenced by the osmotic agents that are administered to the patient then the pressure and volume in the intracranial cavity can also be modified following the treatment. In this thesis research, we hypothesize that administered osmotic agents can influence the mechanical properties of the skull, which can also impact the volume the cavity can hold and subsequently the pressure in the head. This premise was tested by modifying existing mathematical models compiled through two general MATLAB codes that allow the computation of a non-symbolic differential-algebraic initial value problem. Three main features were changed in comparison to current models: the skull's influence on the pressure and volume modulation was tested (inputs were obtained from skull tested under different solutions); pulsatile flow was accounted for on the creation and movement of cerebrospinal fluid; and the input on the mechanical behavior of the cranial vessels was accounted for through previously published continuum-mechanics vessel-behavior models. To complete the model, materials and mechanical properties were obtained through laboratory experiments as well as data collection from existing literature. From our bone test we were able to conclude that there are different factors that affect the mechanical properties of bone in various degrees. There is a mild statistical correlation (p-value 0.05) between the mechanical properties of bone obtained from different regions of the skull samples (2-14mm) and the DPBS and hDPBS solutions. Additionally there is a strong statistical difference (p-value 0.05) between the mechanical properties obtained from cross head speed (0.02, 0.002, and 0.004 (mm/s)) and solution variation (DI, DPBS and hDPBS). Finally, we were able to see that there seems to be a correlation between the mechanical properties of bone, the solution treatments and hypertension; although more test need to be developed to affirm this premise since our results are preliminary.

1. INTRODUCCIÓN:Muchos padres relatan una caída con traumatismo craneal (TCE) para justificar hematomas subdurales (HSD) y/o hemorragias retinianas (HR) debidas a maltrato. El diagnóstico diferencial entre TCE accidental e inflingido en ausencia de otras lesiones es difícil porque no hay estudios que determinen la prevalencia de HSD y/o HR en los traumatismos por caídas.2. HIPÓTESIS:- El mecanismo de producción y la altura de un caída condicionan las lesiones que aparecen en el niño.- El conocimiento de las características de las caídas que tienen como consecuencia HR y lesiones intracraneales facilitará el diagnostico diferencial de maltrato infantil en los casos que las caídas son utilizadas como excusa para justificar estas lesiones.3. OBJETIVOS:a. Conocer qué caídas ocasionan ingresos por TCE en niños menores de dos años de edad y determinar la existencia y uso de medidas de protección para prevenirlas.b. Conocer los tipos de hemorragias cerebrales y retinianas relacionadas con TCE por caída accidental en niños menores de dos años y qué circunstancias favorecen su aparición.c. Valorar si existe algún tipo de hemorragia cerebral o retiniana que pueda considerarse marcador clínico de maltrato físico en niños menores de dos años con TCE atribuido a una caída accidental.4. PACIENTES Y MÉTODO: Estudio de cohortes prospectivo con grupo control histórico. Se realiza un estudio descriptivo de un grupo de niños menores de 2 años ingresados por TCE por caída vertical, se determina la prevalencia de lesiones intracraneales y HR y, posteriormente, se compara con la de un grupo control de niños maltratados.5. RESULTADOS:Se valoran 154 niños con TCE secundario a caída durante 2 años; mediana de edad de 8.6meses (rango 17días-24meses); el 53.2% de sexo masculino. El 88.6% presentan una caída libre, el resto por escaleras. Se caen más frecuentemente del cochecito de paseo (17.8%), la cama (16.8%), la propia altura (15.4%) y el cambiador (10.7%). En 38 (28.7%) existen medidas de protección, 8 (21%) las utilizan. La mediana de altura de las caídas es 90cm (rango 30-900cm). El 87.9% se golpean sobre una superficie dura y lisa. Se calculan las siguientes prevalencias: hematoma epidural 9.1% (IC95%:5.1-14.8%), HSD 0% (IC95%&#8804;1.9%), hemorragia subaracnoidea 0.7% (IC95%:0.02-3.6%), contusión cerebral 1.3% (IC95%:0.2-4.6%) y HR 1.9%(IC95%:0.4-5.6%). No se observaron diferencias significativas en la aparición de lesiones intracraneales y/o HR según la superficie de impacto o el tipo de caída. Se revisan las historias clínicas de los 21 menores de 2 años diagnosticados de maltrato durante 12años; mediana de edad 4.2meses (rango 1.5-18.5meses); 66.7% de sexo masculino. Se obtienen las siguientes prevalencias: hematoma epidural 0%(IC95%&#8804;3.6%), HSD 71.4 (IC95%:47.8-88.7%), hemorragia subaracnoidea 14.3% (IC95%:3-36.3%), contusión cerebral 4.8% (IC95%:0.1-23.8) y HR 42.9% (IC95%:21.8-66%).Se compara la muestra de niños maltratados y la de niños con TCE por caídas y se observan diferencias significativas en las prevalencias de HSD, hemorragias subaracnoideas y HR (p<0.001, p<0.006 y p<0.001 respectivamente. Las razones de odds para las lesiones descritas son de 736.8 (IC95%>39.6), 25.5 (IC95%>2.5) y 37.8 (IC95%>9).6. CONCLUSIONESa. Las caídas que más frecuentemente produjeron TCE con necesidad de ingreso hospitalario, fueron las acontecidas desde el cochecito de paseo, la cama, la propia altura o el cambiador. En prácticamente el 25% de los casos existían medidas de protección diseñadas para prevenir estos accidentes, pero sólo el 5% de los cuidadores las utilizó de forma adecuada.b. Los traumatismos craneales por caída se relacionaron con la existencia de hematomas epidurales y HR unilaterales, así como con la de hemorragias subaracnoideas en precipitaciones de alturas elevadas. No se detectaron HSD debidos a caídas accidentales, ni HR sin la existencia de un hematoma epidural con efecto masa acompañante. Ni la superficie de impacto de la cabeza tras una caída, ni el hecho de que la caída fuera libre o por escaleras, condicionaron diferencias en la aparición de lesiones intracraneales y/o HR.c. Los HSD, asociados o no a HR, deben considerarse marcadores clínicos de maltrato físico en niños menores de dos años con TCE atribuido a una caída accidental, y, por tanto, desencadenar un estudio exhaustivo para descartarlo. / OF DOCTORAL THESIS: "Head trauma resulting from falls in patients under two years of age. Production mechanisms, consequences and differential diagnosis with maltreatment lesions.INTRODUCTION: Falls are a commonly a chief complaint among patients seeking medical attention and the leading cause of injuries requiring hospitalization. Falls are also a frequent excuse to conceal cases of maltreatment in small children. The retinal haemorrhages (RH) and subdural haematomas (SDH) could be useful markers for their differential diagnosis.OBJECTIVES:In children under two:a. To determine falls that cause admissions for head injuries and the measures used for prevent these accidentsb. To determine which cerebral and retinal haemorrhages are related to head injury from vertical fall and the circumstances contributing to their appearance c. To ascertain whether some type of RH and/or SDH could be a useful marker for differential diagnosis between accidental and inflicted head injuries.MATERIALS AND METHODS: Prospective cohort study (children under two admitted for head injury from vertical fall for a period of two years) with historical control group (children under two diagnosed of maltreatment for 12 years).RESULTS:154 patients with accidental head injury were included; 17(11.4%) suffered falls involving stairs. Median falls height was 90cm(range 30-900cm). The most common mechanism of injury was falling from a go-cart, followed by rolling off a bed, fall from a standing position and falling from a changing table. Accident prevention measures were available in 38 cases but only 8 used them. None HSD was detected (CI95%&#8804;1.9%) and 3 patients had RH (prevalence 1.9%;CI 95%:0,4-5.6). The most common intracranial lesion was epidural haematoma in 9.1% of the cases (CI95%:5.1-14.8%)21 charts of children diagnosed of maltreatment were reviewed. The SDH prevalence was 71.4 (CI95%:47.8-88.7%) and the RH, 42.9% (CI95%:21.8-66%).The detection of RH or cerebral haemorrhages was not related neither with the type of fall, nor with surface of impact.Statistically significant differences were found in the prevalence of SDH and RH between inflicted and accidental head injuries (p<0.001); the odds ratio was 736.8 (IC95%>39.6) and 37.8 (IC95%>9).CONCLUSIONS:a. The most common falls causing hospital admission for head injury were from gocart, bed, standing position and changing table. Accident prevention measures were available in 25% of cases, 5% used them.b. Accidental head injury was related with epidural haematomas and unilateral RH. The detection of RH or cerebral haemorrhages was not related neither with the type of fall, nor with the surface of impact.c. The finding of SDH, whether associated or not with RH, must be considered a marker of maltreatment and should be followed by an exhaustive examination in order to discard it.