CNS Injuries in Abusive Head Trauma

Wright, Jason N.

doi:10.2214/ajr.16.17602

Cited by 56 publications

(29 citation statements)

References 102 publications

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“…However, it seems that no fracture pattern is diagnostic for abuse. It is known that multiple, complex, diastatic, depressed, and growing fractures suggest a high-energy mechanism and are therefore suspicious for AHT in the absence of an appropriate clinical history (Fig 1) ( [11][12][13]. Occipital bone fractures are also more commonly seen with AHT (14).…”

Section: Skull Fracturesmentioning

confidence: 99%

“…A wide spectrum of parenchymal imaging findings can be seen in the brain in patients with SDH and bridging vein thrombosis. Additional parenchymal changes often increase the specificity for abusive trauma and enable accurate prognostication (13). The sensitivity of MRI is much higher for detecting these injuries when compared with that of CT alone (14).…”

Section: Parenchymal Injuriesmentioning

confidence: 99%

“…The infant brain may be particularly susceptible to secondary posttraumatic cerebral edema, which could result in vasospasm and decreased cerebral blood flow from elevated intracranial pressure. Injury is often likely to be multifactorial from a combination of apnea, secondary hypotension, reactive vasospasm adjacent to the hemorrhage, respiratory distress, strangulation, and oxidative stress from trauma (2,(13)(14)(15)21,31,(34)(35)(36).…”

Section: Hypoxic Ischemic Injurymentioning

confidence: 99%

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Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas

et al. 2019

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Infants and children under 2 years of age are at greatest risk for devastating neurologic complications following nonaccidental trauma. While a subdural hematoma (SDH) is the most common finding and is often enough to raise suspicion for abuse, no single injury is pathognomonic for abusive head trauma (AHT). Rather, the combination of imaging and physical findings and the clinical presentation help confirm the diagnosis of AHT. Familiarity with the spectrum of findings and proper identification of the imaging abnormalities is important for the radiologist to facilitate treatment and removal of the patient from the abusive environment. Injury is usually a result of shaking, which includes hyperflexion, hyperextension, and rotational forces, and less commonly impact trauma or a combination of both. Key anatomic features unique to the infant's head, neck, and spine and associated biomechanical forces are responsible for entities such as hypoxic ischemic injury, bridging vein thrombosis, SDH, parenchymal lacerations, and spinal and retinal injuries. Although the association of subpial hemorrhage with AHT has not been investigated, it warrants attention in very young infants who endure accidental or inflicted trauma. A combination of CT of the head and MRI of the brain and cervical spine aids in the accurate diagnosis, appropriate management, and subsequent protection of these patients. ©

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Section: Skull Fracturesmentioning

confidence: 99%

Section: Parenchymal Injuriesmentioning

confidence: 99%

Section: Hypoxic Ischemic Injurymentioning

confidence: 99%

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Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas

et al. 2019

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“…10e12 A recent comprehensive review of the neuroradiological findings associated with AHT has been published by Wright. 13 In conjunction with clinical examination, neuroradiological investigations, predominantly computed tomography (CT) and magnetic resonance imaging (MRI) play a complementary role with each modality having its own benefits and limitations. 14…”

Section: Introductionmentioning

confidence: 99%

“…24 The characteristics of SDH associated with AHT, both acute and subacute has been reviewed comprehensively recently. 13 Findings from systematic reviews have demonstrated that the presence of epidural haemorrhage in the context of an isolated skull fracture and scalp swelling is significantly associated with accidental head trauma. 24,25 Subarachnoid haemorrhage as a solitary finding is non-discriminatory.…”

mentioning

confidence: 99%

The neuroimaging mimics of abusive head trauma

Mankad

Chhabda

Lim

et al. 2019

European Journal of Paediatric Neurology

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Abusive head trauma (AHT) is a significant cause of morbidity and mortality in the paediatric population, typically in children under the age of two years. Neuroimaging plays a key role in the diagnostic work up of these patients as information regarding the mechanism of injury is often lacking and the findings on examination can be nonspecific. A number of conditions, both traumatic and atraumatic can mimic AHT based on neuroimaging features alone. The repercussions associated with a diagnosis or misdiagnosis of AHT can be severe and radiologists therefore need to be aware of and familiar with the imaging differentials of AHT. In this paper we review the imaging findings of the radiological mimics of AHT and focus on features that can help differentiate these entities from AHT.

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