Head injury in child abuse: evaluation with MR imaging.

Sato, Yutaka; Yuh, W. T. C.; Smith, Wilbur L.; Alexander, Randell; Kao, Simon C.; Ellerbroek, C.

doi:10.1148/radiology.173.3.2813768

Cited by 134 publications

(52 citation statements)

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“…Homogeneously hyperdense SDH was present in fewer than one-third of our cases; mixed-density SDH, containing both hyperdense and hypodense components, was present in over half of the infants in the present study, in onethird of children in our prior study, 9 and in 91% of infants with AHT in a third study by Vinchon et al 31 Mixeddensity SDH in AHT has been interpreted as prima facie evidence of serial injuries, 6,25 but this concept has recently been challenged. 9,11,32,33,39 One child in our previous study developed a hypodense subdural collection de novo on a second CT scan performed 19 hours after an initial scan showed no SDH in that region.…”

Section: Serial Changes On Ctsupporting

confidence: 44%

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Bradford¹,

Choudhary²,

Dias

2013

PED

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Object The appearance and evolution of neuroimaging abnormalities following abusive head trauma (AHT) is important for establishing the time frame over which these injuries might have occurred. From a legal perspective this frames the timing of the abuse and therefore identifies and excludes potential perpetrators. A previous pilot study involving 33 infants with AHT helped to refine the timing of these injuries but was limited by its small sample size. In the present study, the authors analyzed a larger group of 210 cases involving infants with AHT to chronicle the first appearance and evolution of radiological (CT, MRI) abnormalities. Methods All children younger than 24 months admitted to the Penn State Hershey Medical Center with AHT over a 10-year period were identified from a medical record review; the time of injury was determined through an evaluation of the clinical records. All imaging studies were analyzed, and the appearance and evolution of abnormalities were chronicled on serial neuroimaging studies obtained in the days and weeks after injury. Results One hundred five infants with specific injury dates and available imaging studies were identified; a subset of 43 children additionally had documented times of injury. In infants with homogeneously hyperdense subdural hematomas (SDHs) on initial CT scans, the first hypodense component appeared within the SDH between 0.3 and 16 days after injury, and the last hyperdense subdural component disappeared between 2 and 40 days after injury. In infants with mixed-density SDHs on initial scans, the last hyperdense component disappeared between 1 and 181 days. Parenchymal hypodensities appeared on CT scans performed as early as 1.2 hours, and all were visible within 27 hours after the injury. Rebleeding into SDHs was documented in 17 cases (16%) and was always asymptomatic. Magnetic resonance imaging of the brain was performed in 49 infants. Among those with SDH, 5 patterns were observed. Patterns I and II reflected homogeneous SDH; Pattern I (T1 hyperintensity and T2/FLAIR hypointensity, “early subacute”) more commonly appeared on scans performed earlier after injury compared with Pattern II (T1 hyperintensity and T2/FLAIR hyperintensity, “late subacute”), although there was considerable overlap. Patterns III and IV reflected heterogeneous SDH; Pattern III contained relatively equal mixtures having different intensities, whereas Pattern IV had fluid that was predominantly T1 hypointense and T2/FLAIR hyperintense. Again, Pattern III more commonly appeared on scans performed earlier after injury compared with Pattern IV, although there was significant overlap. Conclusions These data extend the preliminary data reported by Dias and colleagues and provide a framework upon which injuries in AHT can be timed as well as the limitations on such timing estimates.

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Section: Serial Changes On Ctsupporting

confidence: 44%

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Bradford¹,

Choudhary²,

Dias

2013

PED

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“…It is more sensitive in terms of showing soft tissues and it demostrates intraparanchimal hemorrhage, early brain edema and brain damage more clearly and distinctly (44,45). However, sedation which is needed for shooting is harmful in patients who have a tendency to neurologic deterioration (20).…”

Section: Diagnosismentioning

confidence: 99%

“…However, sedation which is needed for shooting is harmful in patients who have a tendency to neurologic deterioration (20). When CT can not explain the clinical findings fully or obscure findings are observed on CT despite neurologic findings, MRI may be needed (45).…”

Section: Diagnosismentioning

confidence: 99%

“…In survivors, blindness and vision disorder develop in 30-65%, spastic paralysis or severe motor disorder develop in 30-60%, epileptic seizures develop in 30% and speech disorders develop in 64% (9,16,53). Microcephaly, stable encephalopathy, deafness, chronic subdural fluid collection, enlargement in the ventricles and brain reduction may also be observed (45,55).…”

Section: Prognosismentioning

confidence: 99%

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Sarsılmış bebek sendromu ve önleme programları

...

2012

Tpa

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Review Sum maryShaken Baby Syndrome often occurs after shaking in response to crying bouts of infants; which are a source of frustration and anger for parents. It results in serious health problems in the infants such as intracranial and retinal bleeding, brain injury and even death. The syndrome can be prevented by providing training to parents, especially in the early postnatal period and increasing awareness about the dangers of shaking. This review aims to draw attention to shaken baby syndrome which is largely unrecognized in our country and to emphasize the importance of the prevention programs. (Turk Arch Ped 2012; 47: 150-156)

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“…In this observational report, the authors describe a distinct form of inflicted brain injury, parenchymal lacerations, also referred to as subcortical clefts, contusional tears, cerebral contusional white matter clefts, and gliding contusions. [1][2][3][4][5][6][7][8][9][10][11][12][13] Parenchymal brain lacerations have been reported in AHT in conjunction with many of the more specific findings of this condition; however, it is not known at what frequency they occur, if at all, in severe accidental head trauma. Since the initial descriptions of traumatic lacerations, there have been no population comparison studies directed at these important predictive lesions, to our knowledge.…”

mentioning

confidence: 99%

Parenchymal Brain Laceration as a Predictor of Abusive Head Trauma

Palifka

Frasier

Metzger

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Accurate differentiation of abusive head trauma and accidental head injury in infants and young children is critical and impacts clinical care, patient prognosis, forensic investigations, and medicolegal proceedings. No specific finding seen on cross-sectional brain imaging has been reported to distinguish abusive head trauma from accidental injury. Our study investigated whether a specific imaging finding, parenchymal brain laceration, is unique to children diagnosed with abusive head trauma.

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Head injury in child abuse: evaluation with MR imaging.

Cited by 134 publications

References 0 publications

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Sarsılmış bebek sendromu ve önleme programları

Parenchymal Brain Laceration as a Predictor of Abusive Head Trauma

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