Big Black Brain Phenomenon: Understanding Clinicoradiological Dissociation in Non-Accidental Traumatic Brain Injury in Children

Abstract

Pediatric traumatic brain injury (TBI) is a major cause of concern worldwide. Non-accidental traumatic (NAT) brain injury is common in infants. Since infants may present with varied presentations post-NAT, a healthy suspicion is required for effective diagnosis. Infants with NAT and, rarely, accidental subdural hemorrhage may exhibit a clinicoradiologically dissociative presentation, with their behavior appearing to reflect better function than what becomes apparent with maturation. Injury to the developing brain can result in extensive damage consistent with the "big black brain" phenomenon, which predicts poor prognosis. Sequential magnetic resonance imaging (MRI) is important to understand insults to the developing brain for follow-up and prognostication.

Managing the “big black brain” in low resource setting: A case report of early outcome after hinge craniotomy

“…[ 13 ] Nonetheless, a study revealed the importance of magnetic resonance imaging follow-up in infants with non-accidental trauma (NAT) for improved brain injury characterization, prognosis, and long-term management, particularly in the “big black brain” phenomenon. [ 1 ] In settings with limited resources, a CT scan is, therefore, still the initial method of imaging the BBB.…”

“…[ 5 , 15 ] It is believed that BBB represents a decompensation of hemispheric cerebral demand as a result of SDH. [ 1 ] Numerous factors may contribute to the formation of the BBB. Due to its high morbidity and mortality, the management of BBB is still contested.…”