Non‐accidental Head Injury, With Particular Reference to Whiplash Shaking Injury and Medico‐legal Aspects

Brown, Jane Κ.; Minns, Robert A.

doi:10.1111/j.1469-8749.1993.tb11563.x

Cited by 90 publications

(25 citation statements)

References 71 publications

(6 reference statements)

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“…on follow up, thereby allowing an assessment of outcome. Interestingly, the outcome of the children in this study is better than that documented in other studies (Brown and Minns 1993, Goldstein et al 1993, Bonnier et al 1995, Haviland and Ross Russell 1997. There may be several reasons for this, other than sampling bias (Goldstein et al 1993, Haviland andRoss Russell 1997).…”

Section: Discussioncontrasting

confidence: 54%

“…The prognosis in NAHI is poor and is worse than in accidental head injury (Brown and Minns 1993, Goldstein et al 1993, Bonnier et al 1995, Duhaime et al 1996, Haviland and Ross Russell 1997. The mechanism of the primary insult in NAHI leads to extensive brain injury.…”

Section: Discussionmentioning

confidence: 99%

“…The neurological morbidity ranges from 57 to 92% in NAHI compared with 22 to 38% in accidental head injury (Brown and Minns 1993, Goldstein et al 1993, Bonnier et al 1995, Duhaine et al 1996, Haviland and Ross Russell 1997 An elevated intracranial pressure (ICP) measurement (30 cm H 2 0) was documented in one of four case reports (Frank et al 1985). Bonnier et al (1995) report the presence of raised ICP without specific figures in 11 of their 13 cases of whiplash-shaking injury.…”

mentioning

confidence: 99%

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The relation between intracranial pressure and outcome in non‐accidental head injury

Barlow

Minns

1999

Develop Med Child Neuro

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The aim of this retrospective study was to ascertain whether physiological derangement and potential secondary brain insult from raised intracranial pressure (ICP) or reduced cerebral perfusion pressure (CPP) in non‐accidental head injury (NAHI) influences outcome. Any child who had a diagnosis of NAHI and had ICP monitoring or measurements during the acute illness was entered in the study. Seventeen children with an average age 5.1 months (range 1 to 20 months) were identified. Details of the acute encephalopathy, lowest mean arterial blood pressure (MAP), mean of maximum ICP measured, lowest CPP, and neurodevelopmental outcome at follow up were obtained from the hospital case notes. Seshia's (1994) outcome classification scale was used. The lowest CPP was very significantly related to outcome (P=0.0047, τ=–0.544). Mean of maximum ICP did not correlate with outcome. The lowest MAP was significantly related to outcome (P=0.039). It was concluded that the degree of secondary brain insult from reduced CPP influences outcome. Developmental Medicine & Child Neurology 1999, 41: 220–225

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The relation between intracranial pressure and outcome in non‐accidental head injury

Barlow

Minns

1999

Develop Med Child Neuro

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“…NAHI occurs most frequently in the first 6 months of life and rarely in children older than 2 years (Duhaime et al 1987, Brown andMinns 1993).…”

Section: Discussionmentioning

confidence: 99%

Early posttraumatic seizures in non‐accidental head injury: relation to outcome

Barlow

Spowart

Minns

2000

Develop Med Child Neuro

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To document the characteristics of early posttraumatic seizures (EPTS) in non‐accidental head injury (NAHI), and examine their relation with outcome, a retrospective study was carried out. All children with NAHI admitted to the Royal Hospital for Sick Children, Edinburgh, since 1981 were identified. The characteristics of EPTS, EEG, and outcome were noted. Forty‐four cases were identified. The average age of children at presentation was 5.9 months. Thirty‐two of these children had EPTS. The median length of follow‐up was 3 years. The mortality rate was six in 44 (14%). The neurodevelopmental outcome correlated significantly with the presence and severity of EPTS (Tau=0.317,p=0.017). Of survivors, 22% developed late posttraumatic epilepsy; the outcome in those with epilepsy was significantly worse than those without (p<0.0001). It was concluded that the severity of the primary brain injury dictates the severity of the EPTS and neurodevelopmental status at follow‐up.

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“…The previously accepted dogma was that 1) parenchymal brain hypodensities, including "big black brain" and the "reversal sign" (cerebral hemispheres appearing more hypodense than either deep nuclei or posterior fossa structures on CT), are commonly absent on initial imaging studies and routinely appear after 24-48 hours have elapsed; 5,35 2) the evolution from acute to chronic subdural hematoma (SDH) requires 1-4 weeks; 1,8,23,35 and 3) mixed-density subdural hemorrhages provide prima facie evidence of repeated episodes of AHT. However, these conclusions were derived from studies of conditions other than AHT.…”

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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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Non‐accidental Head Injury, With Particular Reference to Whiplash Shaking Injury and Medico‐legal Aspects

Cited by 90 publications

References 71 publications

The relation between intracranial pressure and outcome in non‐accidental head injury

The relation between intracranial pressure and outcome in non‐accidental head injury

Early posttraumatic seizures in non‐accidental head injury: relation to outcome

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

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