Evolution of the cranial computed tomography scan in child abuse

Feldman, Kenneth W.; Brewer, David K.; Shaw, Dennis

doi:10.1016/s0145-2134(94)00130-8

Cited by 20 publications

(16 citation statements)

References 12 publications

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“…Feldman et al [8] studied 34 infants with ISIS, all having initial CT scans and 22 having additional scans. Seven (21%) of the 34 initial scans showed no intracranial abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…For example, parenchymal hypodensities are said to arise only after at least 6-48 h have elapsed since the injury [26,30], and chronic subdural collections are said to take 1-4 weeks to appear [5,8,12,22,30]. However, these statements are largely based upon observations in other conditions.…”

Section: Discussionmentioning

confidence: 99%

“…However, these statements are largely based upon observations in other conditions. In particular, the evolution of parenchymal hypodensities in ISIS is presumed to follow the time course of hypodensities after ischemic-anoxic injuries [4,11,26], and the evolution of acute to chronic subdural hematomas in ISIS is presumed to follow the time course of chronic subdural hematomas in elderly adults or animal models [8,14,26,32]. This is the first study to systematically examine the timing of intracranial changes on serial radiographic studies in infants with ISIS.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the available literature suggests that the presence of parenchymal hypodensities on the initial CT scan implies abuse which occurred at least 6-48 h prior [26,30]. The presence of mixed density subdural hematomas suggests multiple episodes of abuse, and the presence of chronic subdural hematomas implies abuse which occurred 1-4 weeks prior [5,8,12,22,30,31].…”

Section: Introductionmentioning

confidence: 99%

“…For example, the suggestion that parenchymal hypodensities in ISIS take 6-48 h to appear is derived largely from the evolution of radiographic changes in ischemic-anoxic injuries [4,11,26]. The suggestion that chronic subdural hematomas require 1-4 weeks to evolve is based largely upon the evolution of subdural and intraparenchymal hemorrhage in adults and animals [8,14,26,32]. The pathophysiological mechanisms underlying ISIS are very different from those underlying either ischemic-anoxic injury or chronic subdural hemorrhage in adults.…”

Section: Introductionmentioning

confidence: 99%

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Serial Radiography in the Infant Shaken Impact Syndrome

et al. 1998

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Certain CT and/or MRI abnormalities have been used medicolegally to time intracranial injuries from the infant shaken impact syndrome (ISIS). For example, parenchymal hypodensities on CT scans are said to arise only after 6–48 h have elapsed postinjury, and the presence of chronic or mixed subdural hematomas suggests injury that occured 1–4 weeks prior. However, these statements are based largely upon inference from data obtained in other conditions such as ischemic anoxic injury and chronic subdural hemorrhage in adults. Direct evidence about the evolution of intracranial injuries in infants with ISIS is sparse, and the radiographic changes following ISIS have never been systematically studied on serial imaging studies. One hundred-seventeen serial CT and MRI scans obtained from 33 infants with ISIS were reviewed retrospectively. The exact scan dates and times were obtained directly from the scans. Acute subdural hemorrhage was the most common intracranial abnormality and was present in 27 (81%) of the 33 infants. Other intracranial abnormalities included chronic subdural collections, subarachnoid hemorrhage, epidural hematomas, parenchymal hypodensities, edema and contusions, and atrophy and encephalomalacia. In 15 of the 33 infants, the injury could be timed with reasonable certainty, and the evolution of the radiographic changes followed over time. Six of the 15 infants had evidence of prior cranial trauma such as chronic subdural collections (5 infants) or mild atrophy (1 infant). Of the remaining 9 infants, parenchymal abnormalities such as hypodensities, edema and contusion appeared in virtually all of the initial scans performed approximately 3 h following the report of injury. One ‘chronic’ subdural collection was absent on the first scan performed 2.75 h postinjury, but appeared on a second scan performed 17 h later, suggesting that some ‘chronic’ subdural fluid collections may arise much sooner than previously thought. These findings challenge some of the current dogma about the timing of radiographic changes following abuse and are important in timing the alleged abuse for legal purposes.

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“…Feldman et al [8] studied 34 infants with ISIS, all having initial CT scans and 22 having additional scans. Seven (21%) of the 34 initial scans showed no intracranial abnormalities.…”

Section: Discussionmentioning

confidence: 99%