Parenchymal Brain Laceration as a Predictor of Abusive Head Trauma

Palifka, L.A.; Frasier, Lori D.; Metzger, Ryan R.; Hedlund, Gary L.

doi:10.3174/ajnr.a4519

Cited by 38 publications

(20 citation statements)

References 15 publications

(25 reference statements)

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“…35 Palifka et al demonstrated parenchymal laceration in 13% (18/137) of cases of AHT, while none were detected in patients with accidental trauma, suggesting parenchymal laceration may also be indicative of AHT. 36 CT only detected half (9/18) of the cases of parenchymal laceration seen on MR, illustrating the importance of MRI in detecting this injury. An older study by Calder et al further demonstrated that contusional tears were present in a group of nine infants under the age of 5 months who died from repeated AHT.…”

Section: Conventionalmentioning

confidence: 97%

Pediatric Abusive Head Trauma: Review of Standard Imaging Evaluation and Typical Findings

et al. 2017

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Evaluation of abusive head trauma (AHT) in children is an ongoing diagnostic challenge, as there are currently no standard criteria or objective tests for differentiating AHT from accidental trauma. The use of neuroradiologic imaging has an increasingly important role in identifying AHT and often involves a combination of skull radiographs, computerized tomography (CT), and conventional magnetic resonance imaging (MRI) with diffusion-weighted imaging, susceptibility-weighted imaging, and occasionally magnetic resonance spectroscopy. Development of more advanced imaging techniques includes diffusion tensor imaging and arterial spin labeling. MRI may provide insight into different mechanisms of injury and long-term impacts of AHT. A better understanding of the available imaging modalities, typical findings, and their respective contribution to an accurate diagnosis can help guide physicians, other health care providers, as well as law enforcement in the evaluation of children with suspected AHT.

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Section: Conventionalmentioning

confidence: 97%

Pediatric Abusive Head Trauma: Review of Standard Imaging Evaluation and Typical Findings

et al. 2017

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“…This certainty is higher for children with more severe presentations or with multiple findings [17,41]. Several characteristic findings have, most frequently, been identified in AHT including subdural hematoma (SDH), brain parenchymal injuries, retinal hemorrhages and rib fractures [2,10,41,42]. In the review by Maguire et al [41], any combination of 3 or more of the significant diagnostic features yielded a positive predictive value of 85%.…”

Section: What Are the Presenting Features Of Aht?mentioning

confidence: 99%

Consensus statement on abusive head trauma in infants and young children

et al. 2018

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Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.

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“…Cerebral white matter (WM) lacerations associated with head trauma have been reported in infants less than 1 year [1,2]. WM lacerations are observed in the unmyelinated WM in early infancy, while patients older than 1 year show traumatic WM injury that is very similar to that observed in adults, such as diffuse axonal injury, callosal injury, and parenchymal hemorrhage [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…It is considered that the poorly myelinated infantile WM with a gelatin-like consistency, the very pliant skull with non-fused sutures, and the shallowness of the subarachnoid space predispose to parenchymal lacerations in the context of shear force generated from trauma [2,5]. WM lacerations have only been observed in young infants with abusive head trauma (AHT), i.e., never with accidental head injury, leading to the concept that WM lacerations may represent a pattern of injury unique to AHT [1]. We first report three teenagers with severe WM lacerations which could be associated with repetitive impacts to their heads.…”

Section: Introductionmentioning

confidence: 99%