nach oben

Pediatric Radiology

Erschienen in:

01.08.2008 | Review

Neuroimaging of nonaccidental head trauma: pitfalls and controversies

verfasst von: Sujan Fernando, Ruby E. Obaldo, Irene R. Walsh, Lisa H. Lowe

Erschienen in: Pediatric Radiology | Ausgabe 8/2008

Einloggen, um Zugang zu erhalten

Abstract

Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma.

Bonnier C, Nassogne MC, Saint-Martin C et al (2003) Neuroimaging of intraparenchymal lesions predicts outcome in shaken baby syndrome. Pediatrics 112:808–814PubMedCrossRef

Bruce DA, Zimmerman RA (1989) Shaken impact syndrome. Pediatr Ann 18:482–492PubMed

Keenan HT, Runyan DK, Marshall SW et al (2003) A population-based study of inflicted traumatic brain injury in young children. JAMA 290:621–626PubMedCrossRef

Reece RM, Sege R (2000) Childhood head injuries: accidental or inflicted? Arch Pediatr Adolesc Med 154:11–15PubMed

Gessner BD, Moore M, Hamilton B et al (2004) The incidence of infant physical abuse in Alaska. Child Abuse Negl 28:9–23PubMedCrossRef

Schnitzer PG, Ewigman BG (2005) Child deaths resulting from inflicted injuries: household risk factors and perpetrator characteristics. Pediatrics 116:e687–e693PubMedCrossRef

Boos SC (2007) Biomechanics of non-accidental head trauma: a work in progress. In: Gyrations 2:2–4. http://www.aspnr.org. Accessed 3 Dec 2007

Case ME, Graham MA, Handy TC et al (2001) Position paper on fatal abusive head injuries in infants and young children. Am J Forensic Med Pathol 22:112–122PubMedCrossRef

Hymel KP, Makoroff KL, Laskey AL et al (2007) Mechanisms, clinical presentations, injuries, and outcomes from inflicted versus noninflicted head trauma during infancy: results of a prospective, multicentered, comparative study. Pediatrics 119:922–929PubMedCrossRef

10.

Lonergan GJ, Baker AM, Morey MK et al (2003) From the archives of the AFIP. Child abuse: radiologic-pathologic correlation. Radiographics 23:811–845PubMedCrossRef

11.

Duhaime AC, Alario AJ, Lewander WJ et al (1992) Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 90:179–185PubMed

12.

Duhaime AC, Gennarelli TA, Thibault LE et al (1987) The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66:409–415PubMed

13.

Frazier LD (2007) Neuroradiologist/pediatrician collaboration in suspected abusive head trauma. Gyrations 2:4–5

14.

Conway JJ, Collins M, Tanz RR et al (1993) The role of bone scintigraphy in detecting child abuse. Semin Nucl Med 23:321–333PubMedCrossRef

15.

Hymel KP, Rumack CM, Hay TC et al (1997) Comparison of intracranial computed tomographic (CT) findings in pediatric abusive and accidental head trauma. Pediatr Radiol 27:743–747PubMedCrossRef

16.

Barnes PD (2007) Imaging of the central nervous system (CNS) in suspected or alleged non-accidental injury. In: Gyrations 2:5–7. http://www.aspnr.org. Accessed 3 Dec 2007

17.

Soul JS, Robertson RL, Tzika AA et al (2001) Time course of changes in diffusion-weighted magnetic resonance imaging in a case of neonatal encephalopathy with defined onset and duration of hypoxic-ischemic insult. Pediatrics 108:1211–1214PubMedCrossRef

18.

Suh DY, Davis PC, Hopkins KL et al (2001) Nonaccidental pediatric head injury: diffusion-weighted imaging findings. Neurosurgery 49:309–318; discussion 318–320PubMedCrossRef

19.

Kleinman PK, Ragland RL (1996) Gadopentetate dimeglumine-enhanced MR imaging of subdural hematoma in an abused infant. AJR 166:1456–1458PubMed

20.

Chen CY, Huang CC, Zimmerman RA et al (2001) High-resolution cranial ultrasound in the shaken-baby syndrome. Neuroradiology 43:653–661PubMedCrossRef

21.

Jaspan T, Narborough G, Punt JA et al (1992) Cerebral contusional tears as a marker of child abuse – detection by cranial sonography. Pediatr Radiol 22:237–245PubMedCrossRef

22.

Amodio J, Spektor V, Pramanik B et al (2005) Spontaneous development of bilateral subdural hematomas in an infant with benign infantile hydrocephalus: color Doppler assessment of vessels traversing extra-axial spaces. Pediatr Radiol 35:1113–1117PubMedCrossRef

23.

Poussaint TY, Moeller KK (2002) Imaging of pediatric head trauma. Neuroimaging Clin N Am 12:271–294, ixPubMedCrossRef

24.

Lowe LH, Bulas DI (2005) Transcranial Doppler imaging in children: sickle cell screening and beyond. Pediatr Radiol 35:54–65PubMedCrossRef

25.

King J, Diefendorf D, Apthorp J et al (1988) Analysis of 429 fractures in 189 battered children. J Pediatr Orthop 8:585–589PubMed

26.

Arnholz D, Hymel KP, Hay TC et al (1998) Bilateral pediatric skull fractures: accident or abuse? J Trauma 45:172–174PubMed

27.

Meservy CJ, Towbin R, McLaurin RL et al (1987) Radiographic characteristics of skull fractures resulting from child abuse. AJR 149:173–175PubMed

28.

Kleinman PK, Spevak MR (1992) Soft tissue swelling and acute skull fractures. J Pediatr 121:737–739PubMedCrossRef

29.

Seifert D, Puschel K (2006) Subgaleal hematoma in child abuse. Forensic Sci Int 157:131–133PubMedCrossRef

30.

Kilani RA, Wetmore J (2006) Neonatal subgaleal hematoma: presentation and outcome – radiological findings and factors associated with mortality. Am J Perinatol 23:41–48PubMedCrossRef

31.

Zimmerman RD, Yurberg E, Russell EJ et al (1982) Falx and interhemispheric fissure on axial CT: I. Normal anatomy. AJR 138:899–904PubMed

32.

Zimmerman RD, Russell EJ, Yurberg E et al (1982) Falx and interhemispheric fissure on axial CT: II. Recognition and differentiation of interhemispheric subarachnoid and subdural hemorrhage. AJNR 3:635–642PubMed

33.

Han BK, Towbin RB, De Courten-Myers G et al (1990) Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children. AJR 154:361–368PubMed

34.

Parker LA (2005) Part 1: early recognition and treatment of birth trauma: injuries to the head and face. Adv Neonatal Care 5:288–297; quiz 298–300PubMedCrossRef

35.

Whitby EH, Griffiths PD, Rutter S et al (2004) Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 363:846–851PubMedCrossRef

36.

Barnes PD, Robson CD (2000) CT findings in hyperacute nonaccidental brain injury. Pediatr Radiol 30:74–81PubMedCrossRef

37.

Greenberg J, Cohen WA, Cooper PR (1985) The “hyperacute” extraaxial intracranial hematoma: computed tomographic findings and clinical significance. Neurosurgery 17:48–56PubMedCrossRef

38.

Sargent S, Kennedy JG, Kaplan JA (1996) “Hyperacute” subdural hematoma: CT mimic of recurrent episodes of bleeding in the setting of child abuse. J Forensic Sci 41:314–316PubMed

39.

Ravid S, Maytal J (2003) External hydrocephalus: a probable cause for subdural hematoma in infancy. Pediatr Neurol 28:139–141PubMedCrossRef

40.

Rupprecht T, Lauffer K, Storr U et al (1996) Extra-cerebral intracranial fluid collections in childhood: differentiation between benign subarachnoid space enlargement and subdural effusion using color-coded duplex ultrasound. Klin Padiatr 208:97–102PubMed

41.

Hymel KP, Jenny C, Block RW (2002) Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: addressing the forensic controversies. Child Maltreat 7:329–348PubMedCrossRef

42.

Piatt JH Jr (1999) A pitfall in the diagnosis of child abuse: external hydrocephalus, subdural hematoma, and retinal hemorrhages. Neurosurg Focus 7:e4PubMedCrossRef

43.

Pittman T (2003) Significance of a subdural hematoma in a child with external hydrocephalus. Pediatr Neurosurg 39:57–59PubMedCrossRef

44.

Geddes JF, Tasker RC, Hackshaw AK et al (2003) Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in ‘shaken baby syndrome’? Neuropathol Appl Neurobiol 29:14–22PubMedCrossRef

45.

Goetting MG, Sowa B (1990) Retinal hemorrhage after cardiopulmonary resuscitation in children: an etiologic reevaluation. Pediatrics 85:585–588PubMed

46.

Odom A, Christ E, Kerr N et al (1997) Prevalence of retinal hemorrhages in pediatric patients after in-hospital cardiopulmonary resuscitation: a prospective study. Pediatrics 99:E3PubMedCrossRef

47.

Punt J, Bonshek RE, Jaspan T et al (2004) The ‘unified hypothesis’ of Geddes et al. is not supported by the data. Pediatr Rehabil 7:173–184PubMedCrossRef

48.

Richards PG, Bertocci GE, Bonshek RE et al (2006) Shaken baby syndrome. Arch Dis Child 91:205–206PubMedCrossRef

49.

Smith C, Bell JE, Keeling JW et al (2003) Dural haemorrhage in nontraumatic infant deaths: does it explain the bleeding in ‘shaken baby syndrome’? Geddes JE et al. A response. Neuropathol Appl Neurobiol 29:411–412; author reply 412–413PubMedCrossRef

50.

Ghatan S, Ellenbogen RG (2002) Pediatric spine and spinal cord injury after inflicted trauma. Neurosurg Clin N Am 13:227–233PubMedCrossRef

51.

Kleinman PK, Shelton YA (1997) Hangman’s fracture in an abused infant: imaging features. Pediatr Radiol 27:776–777PubMedCrossRef

52.

Rooks VJ, Sisler C, Burton B (1998) Cervical spine injury in child abuse: report of two cases. Pediatr Radiol 28:193–195PubMedCrossRef

53.

Thomas NH, Robinson L, Evans A et al (1995) The floppy infant: a new manifestation of nonaccidental injury. Pediatr Neurosurg 23:188–191PubMedCrossRef

54.

Hymel KP, Hall CA (2005) Diagnosing pediatric head trauma. Pediatr Ann 34:358–370PubMed

55.

Bechtel K, Stoessel K, Leventhal JM et al (2004) Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics 114:165–168PubMedCrossRef

56.

Pitetti RD, Maffei F, Chang K et al (2002) Prevalence of retinal hemorrhages and child abuse in children who present with an apparent life-threatening event. Pediatrics 110:557–562PubMedCrossRef

57.

Alexander RC, Schor DP, Smith WL Jr (1986) Magnetic resonance imaging of intracranial injuries from child abuse. J Pediatr 109:975–979PubMedCrossRef

58.

Levin AV, Ells A, Schloff S (2004) Suspected child abuse victims. Ophthalmology 111:1794; author reply 1794–1795PubMedCrossRef

59.

Morad Y, Kim YM, Armstrong DC et al (2002) Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome. Am J Ophthalmol 134:354–359PubMedCrossRef

60.

Levin AV (2001) Ocular manifestations of child abuse. Lippincott Williams and Wilkins, Philadelphia

61.

Gnanaraj L, Gilliland MG, Yahya RR et al (2007) Ocular manifestations of crush head injury in children. Eye 21:5–10PubMedCrossRef

62.

Merten DF, Osborne DR, Radkowski MA et al (1984) Craniocerebral trauma in the child abuse syndrome: radiological observations. Pediatr Radiol 14:272–277PubMedCrossRef

63.

Maxeiner H (2001) Demonstration and interpretation of bridging vein ruptures in cases of infantile subdural bleedings. J Forensic Sci 46:85–93PubMed

64.

Ikeda A, Sato O, Tsugane R et al (1987) Infantile acute subdural hematoma. Childs Nerv Syst 3:19–22PubMedCrossRef

65.

Knapp JF, Soden SE, Dasouki MJ et al (2002) A 9-month-old baby with subdural hematomas, retinal hemorrhages, and developmental delay. Pediatr Emerg Care 18:44–47PubMedCrossRef

66.

Hartley LM, Khwaja OS, Verity CM (2001) Glutaric aciduria type 1 and nonaccidental head injury. Pediatrics 107:174–175PubMedCrossRef

67.

Rooms L, Fitzgerald N, McClain KL (2003) Hemophagocytic lymphohistiocytosis masquerading as child abuse: presentation of three cases and review of central nervous system findings in hemophagocytic lymphohistiocytosis. Pediatrics 111:e636–640PubMedCrossRef

68.

Fitzgerald NE, MacClain KL (2003) Imaging characteristics of hemophagocytic lymphohistiocytosis. Pediatr Radiol 33:392–401PubMed

Titel: Neuroimaging of nonaccidental head trauma: pitfalls and controversies
verfasst von: Sujan Fernando
Ruby E. Obaldo
Irene R. Walsh
Lisa H. Lowe
Publikationsdatum: 01.08.2008
Verlag: Springer-Verlag
Erschienen in: Pediatric Radiology / Ausgabe 8/2008
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-007-0729-1

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Neuroimaging of nonaccidental head trauma: pitfalls and controversies

Abstract

Neu im Fachgebiet Radiologie

Akuter Schwindel: Wann lohnt sich eine MRT?

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

S3-Leitlinie zu Pankreaskrebs aktualisiert

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Update Radiologie

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2008

Optimal imaging strategy for community-acquired Staphylococcus aureus musculoskeletal infections in children

Thalassaemia with extensive intracranial calcifications

Biotinidase deficiency: a reversible metabolic encephalopathy. Neuroimaging and MR spectroscopic findings in a series of four patients

Allergic bronchopulmonary aspergillosis: a unique presentation in a pediatric patient

Bridging bronchus and sling left pulmonary artery: a rare entity demonstrated by coronal CT with 3-D rendering display and minimal-intensity projections

Craniofacial and temporal bone CT findings in cleidocranial dysplasia

Neu im Fachgebiet Radiologie

Akuter Schwindel: Wann lohnt sich eine MRT?

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

S3-Leitlinie zu Pankreaskrebs aktualisiert

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Update Radiologie