Hypoxic-Ischemic Injury Complicates Inflicted and Accidental Traumatic Brain Injury in Young Children: The Role of Diffusion-Weighted Imaging

Ichord, Rebecca; Naim, Maryam Y.; Pollock, Avrum N.; Nance, Michael L.; Margulies, Susan S.; Christian, Cindy W.

doi:10.1089/neu.2006.0087

Cited by 120 publications

(86 citation statements)

References 29 publications

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“…MRI is the optimal modality for assessing intracranial injury, including cerebral hypoxia and ischemia, and is used for all children with abnormal CT scans, asymptomatic infants with noncranial abusive injuries, and for follow-up of identified trauma. 140,141 Ultrasound is often used in the initial evaluation of macrocephaly in young infants and can identify large extra-axial cerebrospinal fluid collections. Any abnormal ultrasound study requires more sophisticated follow-up with MRI.…”

Section: Head Injuriesmentioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

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450

301

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Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.

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Section: Head Injuriesmentioning

confidence: 99%

The Evaluation of Suspected Child Physical Abuse

Christian¹

2015

Pediatrics

Self Cite

450

301

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“…A number of studies have described the utility of conventional MRI sequences, [18][19][20] diffusion-weighted imaging, 21,22 DTI, 23,24 and susceptibility-weighted imaging 25,26 in patients with TBI. This literature demonstrates the superiority of MRI over CT for the visualization of lesions.…”

Section: Critical Care Medicinementioning

confidence: 99%

Assessment of White Matter Injury and Outcome in Severe Brain Trauma. A Prospective Multicenter Cohort

Galanaud¹,

Perlbarg²,

Gupta³

et al. 2013

Survey of Anesthesiology

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“…Moreover, diffusion and ADC sequences suggest that these parenchymal hypodensities are ischemic in nature. 3,7,18,24,28 Multiple converging lines of evidence provide support for an ischemic mechanism for brain injuries in AHT. The high incidence of apnea and disordered breathing in AHT has been well documented.…”

Section: Contribution Of Neuroimaging To Timing Of Ahtmentioning

confidence: 99%

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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Hypoxic-Ischemic Injury Complicates Inflicted and Accidental Traumatic Brain Injury in Young Children: The Role of Diffusion-Weighted Imaging

Cited by 120 publications

References 29 publications

The Evaluation of Suspected Child Physical Abuse

The Evaluation of Suspected Child Physical Abuse

Assessment of White Matter Injury and Outcome in Severe Brain Trauma. A Prospective Multicenter Cohort

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

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