Neuroimaging differential diagnoses to abusive head trauma

Girard, Nadine; Brunel, H.; Dory‐Lautrec, Philippe; Chabrol, B.

doi:10.1007/s00247-015-3509-3

Cited by 33 publications

(15 citation statements)

References 46 publications

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“…For an acutely ill child with neurologic impairment, an optimal imaging strategy involves initial unenhanced CT with 3-D reformatted images of the calvarium [97], followed by a full multisequence MRI of the brain, cervical, thoracic and lumbar spine as soon as feasible. Children who are intact neurologically can be first imaged using MR [98][99][100][101]. Suspicion of AHT warrants comprehensive imaging and the decision rule developed from a network of emergency departments regarding the use of imaging in low risk blunt head trauma does not apply when there are concerns for AHT [102][103][104] Subdural hematoma is the most commonly observed intracranial lesion (in up to 90%) in young infants with AHT and is most commonly parafalcine in location [110,111].…”

Section: Laboratory Studies and Imagingmentioning

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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Section: Laboratory Studies and Imagingmentioning

confidence: 99%

Consensus statement on abusive head trauma in infants and young children

et al. 2018

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“…To better characterize intraparenchymal injury, conventional magnetic resonance imaging (MRI), including gradient echo (GRE), T1-weighted, T2-weighted, and fluidattenuated inversion recovery (FLAIR), is routinely performed. 30 These sequences have the benefit of being able to demonstrate recurrent episodes and evolution of injury by helping to date subacute and chronic bleeds (►Fig. 1E, ►Fig.…”

Section: Conventionalmentioning

confidence: 99%

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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“…Intracranial malformations, cerebral infections, coagulation and hematological disorders, and metabolic disorders were included as other differential diagnoses of subdural hemorrhages [21]. However, MR angiography did not show intracranial malformations in this patient.…”

Section: Discussionmentioning

confidence: 99%

Severe Acute Subdural Hemorrhages in a Patient with Glutaric Acidemia Type 1 under Recommended Treatment

Ishige¹,

Fuchigami²,

Ogawa³

et al. 2016

Pediatr Neurosurg

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Glutaric acidemia type 1 is a rare autosomal recessive disease caused by a deficiency of glutaryl-CoA dehydrogenase. Previous studies have reported subdural hemorrhage in untreated patients with glutaric acidemia type 1. However, there is only one report of severe acute subdural hemorrhage after minor head trauma in a patient with glutaric acidemia type 1 under guideline-recommended treatment. We report a second case of life-threatening severe acute subdural hemorrhage after a minor head trauma in a patient with glutaric acidemia type 1. This patient was previously diagnosed by newborn screening, and treatment began at 25 days of age. Early diagnosis and guideline-recommended treatment produce better outcomes for patients with glutaric acidemia type 1, although the risk of subdural hemorrhage remains.

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Neuroimaging differential diagnoses to abusive head trauma

Cited by 33 publications

References 46 publications

Consensus statement on abusive head trauma in infants and young children

Consensus statement on abusive head trauma in infants and young children

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

Severe Acute Subdural Hemorrhages in a Patient with Glutaric Acidemia Type 1 under Recommended Treatment

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