MRI Findings in Pediatric Abusive Head Trauma: A Review

Abstract

Trauma is the most common cause of death and significant morbidity in childhood; abusive head trauma (AHT) is a prominent cause of significant morbidity and mortality in children younger than 2 years old. Correctly diagnosing AHT is challenging both clinically and radiologically. The primary diagnostic challenges are that the abused children are usually too young to provide an adequate history, perpetrators are unlikely to provide truthful account of trauma, and clinicians may be biased in their assessment of potentially abused children. The main radiological challenge is that there is no single imaging finding that is independently specific for or diagnostic of AHT. The radiological evaluation should be based on the multiplicity and severity of findings and an inconsistency with the provided mechanism of trauma. While the most common neuroimaging finding in AHT is subdural hemorrhage, other less well‐known magnetic resonance imaging (MRI) findings such as the “lollipop sign” or “tadpole sign,” parenchymal or cortical lacerations, subpial hemorrhage, cranio‐cervical junction injuries including retroclival hematomas, as well as diffuse hypoxic brain injury have been identified and described in the recent literature. While AHT is ultimately a clinical diagnosis combining history, exam, and neuroimaging, familiarity with the typical as well as the less‐well known MRI findings will improve recognition of AHT by radiologists.

Abusive head trauma in court: a multi-center study on criminal proceedings in Germany

“…On the one hand, detailed clinical diagnostics is frequently not performed before the death of a child occurring suddenly, thus impeding an adequate comparability of mere autopsy and clinical cases. On the other hand, the study cohort should intentionally comprise cases from the clinical routine, i.e., cases with the typical SBS/AHT findings that pediatricians, neurosurgeons, ophthalmologists, radiologists, or clinical forensic physicians are frequently confronted with [8,11,12,27,[30][31][32][33][34][35][36][37][38][39]. Hence, the present study cohort comprises cases with non-fatal outcome except for three.…”

Shaken Baby Syndrome: Magnetic Resonance Imaging Features in Abusive Head Trauma

“…Although SDH is the most common finding in SBS, the presence of SDH itself does not prove the syndrome. SDH should be carefully evaluated along with clinical history and physical examination to differentiate other possible causes [28]. For example, in the first few months of life, parturitional SDH cannot be differentiated by inflicted trauma, based on imaging findings alone.…”

“…Subarachnoid hemorrhage (SAH) represents another common, though non-specific, neuroradiological finding that could be detected in AHT [28] (Figure 2). In shaking injury, tearing of small vessels in the pia and arachnoid causes SAH, more often seen along the high cerebral convexities or within the interhemispheric fissure.…”

“…In EDH blood accumulates beneath the inner skull table and above the dura after a blunt impact trauma and consequent rupture of the middle meningeal arteries [37]. Skull fracture can be present and the trauma history should be carefully evaluated in these suspected cases [28].…”

Brückenvenenverletzungen bei Schütteltrauma

“…Hinsichtlich des radiologischen Beitrags zur Diagnostik des SBS/AHT betonten Orman et al [38] kürzlich, dass neben dem bei SBS/AHT häufigsten neuroradiologischen Befund des Subduralhämatoms auch die sog. "weniger bekannten MRT-Befunde" berücksichtigt werden sollten.…”