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

Abstract

In the context of child abuse spectrum, abusive head trauma (AHT) represents the leading cause of fatal head injuries in children less than 2 years of age. Immature brain is characterized by high water content, partially myelinated neurons, and prominent subarachnoid space, thus being susceptible of devastating damage as consequence of acceleration–deceleration and rotational forces developed by violent shaking mechanism. Diagnosis of AHT is not straightforward and represents a medical, forensic, and social challenge, based on a multidisciplinary approach. Beside a detailed anamnesis, neuroimaging is essential to identify signs suggestive of AHT, often in absence of external detectable lesions. Magnetic resonance imaging (MRI) represents the radiation-free modality of choice to investigate the most typical findings in AHT, such as subdural hematoma, retinal hemorrhage, and hypoxic-ischemic damage and it also allows to detect more subtle signs as parenchymal lacerations, cranio-cervical junction, and spinal injuries. This paper is intended to review the main MRI findings of AHT in the central nervous system of infants, with a specific focus on both hemorrhagic and non-hemorrhagic injuries caused by the pathological mechanisms of shaking. Furthermore, this review provides a brief overview about the most appropriate and feasible MRI protocol to help neuroradiologists identifying AHT in clinical practice.

Shaken Baby Syndrome and Accidental Traumatic Brain Injury: Characteristics and Effects on Legal Judgment

“…3). Understanding the characteristics of stage 2 or higher bilateral bleeding or parenchymal injury on brain MRI may help add scientific evidence to the diagnosis of child abuse [39], and strengthen the legal basis [40].…”

New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review

“…Finally, rapid accelerations and decelerations can also damage the accessory structures of the eyeball, producing typical aspects such as periorbital fat or extrinsic muscle hemorrhages [76]. In order to highlight retro-ocular hemorrhagic phenomena in living subjects, it is useful to consider the undoubted usefulness of an MRI investigation conducted in gradient echo T2 (GRE T2-w) or susceptibility-weighted imaging (SWI) sequences, which have a high diagnostic sensitivity and specificity but are not very useful for dating phenomena [77,78].…”

“…Subsequently, 123 articles were excluded because they did not meet the inclusion criteria. Finally, 16 articles were included for qualitative analysis [71,78,[87][88][89][90][91][92][93][94][95][96][97][98][99][100] (Figure 1).…”

Non-accidental Trauma in Infants: a Review of Evidence-Based Strategies for Diagnosis, Management, and Prevention

“…Although SDHs associated with AHT can vary in size, location, and density, they are often multiple and are frequently found overlying the cerebral convexity, along the falx, or within the posterior fossa [57]. Imaging may also reveal other injuries including parenchymal contusions or lacerations, diffuse axonal injury, or signs of cerebral ischemia, edema, or infarct [58,59]. Imaging should be read by an experienced neuroradiologist who is familiar with potential mimics of AHT and normal suture variants of the developing skull [60,61].…”