An In-Depth Analysis of Brain and Spine Neuroimaging in Children with Abusive Head Trauma: Beyond the Classic Imaging Findings

Abstract

BACKGROUND AND PURPOSE: Abusive head trauma is the leading cause of morbidity and mortality in young children. Radiology provides valuable information for this challenging diagnosis, but no single neuroimaging finding is independently diagnostic of abusive head trauma. Our purposes were to describe the prevalence of brain and spine neuroimaging findings and to analyze the association of neuroimaging findings with clinical factors to determine which neuroimaging findings may be used as prognostic indicators.

Benign enlargement of the subarachnoid spaces and subdural collections—when to evaluate for abuse

“…In infants with macrocephaly and subdural collections, the possibility of abusive injury may be supported by the presence of concomitant suspicious injuries in various organs and sites: co-existing parenchymal injuries or cytotoxic oedema, bridging vein thrombosis/rupture, subdural collections in different locations (around right frontal lobe, around left frontal lobe, convexity, interhemispheric fissure, posterior fossa), spinal injuries (including ligamentous injuries and subdural spinal haematomas), unexplained fractures, especially classic metaphyseal lesions (CMLs), rib and skull fractures [23,[29][30][31][32][53][54][55][56][57][58][59][60][61][62]. Skin, oral and genital stigmata are extremely important to identify, strongly supporting the hypothesis of abuse in the absence of any additional finding in a child with BESS and subdural collection(s) [63][64][65].…”