Encephalopathy and death in infants with abusive head trauma is due to hypoxic-ischemic injury following local brain trauma to vital brainstem centers

Abstract

AHT victims in our cohort do not have diffuse TBI or tDAI. Instead, our findings indicate that the encephalopathy in AHT is the due to hypoxic-ischemic injury probably as the result of respiratory arrest due to local damage to parts of the CPG in the brainstem.

Elevated admission international normalized ratio strongly predicts mortality in victims of abusive head trauma

“…30,46 The clinical symptoms of AHT is supported by postmortem neuropathologic evaluation of brain tissue that demonstrates findings of hypoxic-ischemic encephalopathy rather than diffuse axonal injury as well as local damage specifically to the brain stem. 44,47 Despite this difference in the mechanism of traumatic brain damage between accidental and AHT patients, our study demonstrates that INR predicts mortality in the AHT cohort as well. This suggests that abusive and accidental head injury populations share some common pathway resulting in the dysregulation of the coagulation system, despite the differing injury mechanisms, the variation and uncertainty about the time of injury in AHT, and the repeated insults in AHT versus one single traumatic event in accidental trauma.…”

“…Traditionally, brain injury and encephalopathy from AHT were thought to be caused by a primary traumatic mechanism similar to accidental head trauma that encompassed subdural hemorrhage, subarachnoid hemorrhage, parenchymal shear, or brain contusion causing diffuse axonal injury. 44 However, the abusive head injury population differs clinically from the accidental head injury population in that they have higher mortality rates 1-3 and worse neurologic outcomes. 1,[4][5][6][7] It is now widely theorized that the pathophysiology of brain damage in AHT does not result from a direct traumatic mechanism but instead from a hypoxic-ischemic insult that occurs after trauma-induced apnea.…”

“…1,[4][5][6][7] It is now widely theorized that the pathophysiology of brain damage in AHT does not result from a direct traumatic mechanism but instead from a hypoxic-ischemic insult that occurs after trauma-induced apnea. [44][45][46][47] Hyperextension injury to the neck caused by violent shaking has been implicated in damaging the central pattern generator of respiration in the brain stem. 45 Clinical evidence of this pathophysiologic process includes the fact that most severely injured children have prehospital apnea or respiratory compromise, and many require intubation upon arrival; 46,48 a substantial number also have early seizures, hypotension, and acidosis at admission blood work.…”

Altered plasma-type gelsolin and amyloid-β in neonates with hypoxic-ischaemic encephalopathy under therapeutic hypothermia

“…Also, a previous study has related encephalopathy and death in infants with abusive head trauma to hypoxic-ischemic injury, accompanied by increased APP levels in the brainstem and the cerebellum. 23,24 It is therefore feasible, that reduced plasma Aβ levels in HIE patients might also relate to increased central amyloidosis, while hypothermia counterbalances this effect. However, we cannot unequivocally point towards this possibility.…”

Kindesmisshandlung: Symptome erkennen in der Notaufnahme

“…Anschließend sei das Kind wieder "normal" gewesen, abgesehen davon, dass es seitdem die sonst übliche Nahrungsaufnahme verweigert.Einriss von Brückenvenen mit Ausbildung des subduralen Hämatoms. Als Ursache für die Enzephalopathie werden zum einen diffuse axonale Schädigungen, zum anderen eine hypoxisch-ischämische Enzephalopathie diskutiert[21]. Äußerliche Verletzungen am Kopf sowie Schädelfrakturen können durch zusätzlichen Anprall des kindlichen Kopfes entstehen.Die klinische Symptomatik ist sehr variabel und geprägt von der Schwere der intrakraniellen Verletzungen.…”