Complex Pathophysiology of Abusive Head Trauma with Poor Neurological Outcome in Infants

Abstract

Abusive head trauma (AHT) in infants, especially acute subdural hematoma, has an extremely poor outcome. The most decisive and important finding is the appearance of a widespread low-density area on head computed tomography. This phenomenon was traditionally thought to be caused by cerebral ischemia. However, many other pathophysiological abnormalities have been found to be intricately involved. Recent studies have found that status epilepticus and hyperperfusion injures are the major causes. Another serious problem associated with AHT is cardiopulmonary arrest (CPA). Many infants are reported to visit to the hospital with CPA, and its pathophysiology has not been fully elucidated. This paper examines the background of these pathological conditions and associated factors and elucidate the pathophysiological mechanisms resulting in poor outcomes in AHT. In addition to the intensity of assault on the head, the peculiar pathophysiological characteristics in infants, as well as the social background specific to child abuse, are found to be associated with poor outcome.

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“…[ 16 ] This phenomenon is unique to infant head trauma and was rarely observed in adults. [ 19 ] Brain oxygen supply-demand mismatch and systemic insults that impair oxygen delivery may contribute to the formation of BBB. [ 7 ] Recent animal studies also revealed that apnea, hypoventilation, and seizures are part of the pathophysiological cascade of the BBB.…”

“…[ 18 ] Diffuse brain injury and injury to the respiratory center are unquestionably attributable to CPA in abusive head trauma in infants. [ 18 , 19 ] Another study added three patterns of extensive low-density area, which is typical of BBB, and their pathophysiology based on when it occurs, where it occurs, and the presence of midline shift. [ 19 ] It has been demonstrated that early surgical evacuation of blood near the cerebral cortex is not protective against the development of BBB.…”

“…[18,19] Another study added three patterns of extensive low-density area, which is typical of BBB, and their pathophysiology based on when it occurs, where it occurs, and the presence of midline shift. [19] It has been demonstrated that early surgical evacuation of blood near the cerebral cortex is not protective against the development of BBB. [25] Momose et al identified five predictors for cerebral infarction following acute SDH: Seizure, consciousness disturbance at admission, absence of skull fracture, hematoma thickness, and midline shift, more than 5 mm more than 3 mm on CT scan, respectively.…”