Magnetic resonance imaging in acute non‐accidental head injury

Barlow, KM; Gibson, R J; McPhillips, Maeve; Minns, R. A.

doi:10.1111/j.1651-2227.1999.tb00034.x

Cited by 45 publications

(6 citation statements)

References 22 publications

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“…The high water content of the neonatal brain makes it difficult to handle during autopsy, even when adequately fixed. Subdural hemorrhage is the commonest type of injury found and this is in keeping with pathologic evidence and CT studies (9). It is caused by damage to the bridging veins which drain from the cortex into the superficial venous sinuses.…”

Section: Discussionsupporting

confidence: 68%

Child Abuse: Practical Application of Autopsy, Radiological, and Microscopic Studies*

Guilbeau‐Frugier¹,

Capuani²,

Sévely³

et al. 2008

Journal of Forensic Sciences

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A 17-month-old male infant died at home. The infant's right arm was immobilized because of a humeral fracture 1 month earlier. The circumstances of death appeared unclear to the police investigators and a medicolegal autopsy was carried out. External examination revealed diffuse ecchymoses of varying color. Postmortem imaging was performed prior to autopsy (X-rays, multislice computed tomography [MSCT], and focused brain magnetic resonance imaging [MRI]). These investigations revealed four rib fractures of varying ages, one of which was posterior. Cerebral and pericerebral traumatic lesions were also diagnosed: bilateral subdural hematomas, intraventricular, meningeal, and interpedoncular hemorrhages. In the abdomen, fresh blood was visible within the anterior abdominal wall and the mesenteric root. Autopsy and microscopic study confirmed these lesions. This case report illustrates the valuable assistance rendered by MSCT and MRI to diagnose abuse when a child has died in unclear circumstances.

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Section: Discussionsupporting

confidence: 68%

Child Abuse: Practical Application of Autopsy, Radiological, and Microscopic Studies*

Guilbeau‐Frugier¹,

Capuani²,

Sévely³

et al. 2008

Journal of Forensic Sciences

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“…The interhemispheric fissure was the next commonest site, followed by the posterior and middle cranial fossa. This is similar to the findings of Sato and colleagues, 14 but differs from the observations of Barlow and colleagues, 13 who cite the subtemporal region as the commonest site of SDH in NAHI. Interhemispheric blood was most often seen following NAHI; indeed, apart from NAHI, SDH in the interhemispheric fissures, and posterior and middle cranial fossa was only otherwise seen following severe accidental trauma (cases of road traffic accident) and coagulopathy.…”

contrasting

confidence: 43%

“…The diagnosis of SDH is made by cranial imaging, mainly computed tomography (CT) and magnetic resonance imaging (MRI); the features of SDH due to non-accidental head injury (NAHI) are well described. [8][9][10][11] MRI is used as an adjunct to CT in the radiological assessment of SDH to detect subdural blood in areas not well seen on CT, [12][13][14] or small volume SDHs, to differentiate subdural and subarachnoid blood and to show parenchymal injuries.…”

mentioning

confidence: 99%

Chronic nonbacterial osteomyelitis

Winters

Tatum

2014

Current Opinion in Otolaryngology & Head and Neck Surgery

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Aims: To review the neuroimaging of a series of infants and young children admitted to hospital with subdural haemorrhage (SDH). Methods: Neuroradiological investigations of 74 children under 2 years of age, from South Wales and southwest England, in whom an SDH or subdural effusion had been diagnosed between 1992 and 2001, were reviewed. Two paediatric neuroradiologists blinded to the original radiological report reviewed all the relevant images. Results: Neuroradiological review of images identified radiological features which were highly suggestive of non-accidental head injury (NAHI). Interhemispheric haemorrhages and SDHs in multiple sites or of different densities were almost exclusively seen in NAHI. MRI was more sensitive in identifying SDHs of different signal characteristics, posterior and middle cranial fossa bleeds, and parenchymal changes in the brain. CT scans, if performed with suboptimal protocols, were likely to miss small subdural bleeds. Conclusions: Guidelines for neuroimaging in suspected NAHI are recommended. A radiologist with experience in NAHI should report or review these scans. The initial investigation should be CT, but MRI will also be necessary in most cases. Head CT should be an integral part of the skeletal survey in all infants less than 6 months of age referred for child protection investigation, and in children less than 2 years where child abuse is suspected and there are neurological signs, retinal haemorrhages, or fractures.

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“…3,[7][8][9][10][11] There was no significant difference in mean age, gender ratio, frequency of mortality, main symptoms at presentation (vomiting, loss of consciousness, cardiopulmonary arrest, etc), ecchymoses, fractures, or retinal hemorrhages between the group with full confessions (n ϭ 29) and the group without full confessions (n ϭ 83) ( Table 1). Because of the retrospective and unique character of the study, no power calculations were performed before beginning the study.…”

Section: Discussionmentioning

confidence: 95%

Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking

et al. 2010

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OBJECTIVE: Confessions are uncommon in abusive head trauma (AHT) cases, and there is debate over whether shaking alone can cause the injuries characteristic of AHT. The objective of this article is to correlate legal statements by perpetrators with medical documentation to offer insights into the mechanism of injury. METHODS:In this retrospective observational study we examined forensic evidence from 112 cases referred for AHT over a 7-year period. We compared 29 cases in which a perpetrator confessed to violence toward the child with 83 cases in which there was no confession. Inclusion criteria were subdural hematoma (SDH) on computed tomography and perpetrator admission of a causal relationship between the violence inflicted and the child's symptoms. Groups were compared by using Student's t test for age and Fisher's exact test for gender, death, fractures, retinal hemorrhages, ecchymoses, symptoms, and SDH patterns. All medical records from birth to diagnosis, imaging studies, and written investigation reports were reviewed. RESULTS:All confessions came from forensic investigations. There was no statistically significant difference between the 2 groups for any of the variables studied. Shaking was described as extremely violent (100%) and was repeated (55%) from 2 to 30 times (mean: 10) because it stopped the infant's crying (62.5%). Impact was uncommon (24%). No correlation was found between repeated shaking and SDH densities. CONCLUSIONS:This unique forensic case series confirms the violence of shaking. The high frequency of habitual AHT is a strong argument for reporting suspected cases to judicial authorities and helps to explain the difficulty in dating the injuries.

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Magnetic resonance imaging in acute non‐accidental head injury

Cited by 45 publications

References 22 publications

Child Abuse: Practical Application of Autopsy, Radiological, and Microscopic Studies*

Child Abuse: Practical Application of Autopsy, Radiological, and Microscopic Studies*

Chronic nonbacterial osteomyelitis

Abusive Head Trauma: Judicial Admissions Highlight Violent and Repetitive Shaking

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