Spinal subdural hemorrhage in abusive head trauma: a pictorial review

Garcia-Pires, Flavio; Jayappa, Sateesh; Desai, Shivang; Ramakrishnaiah, Raghu H.; Choudhary, Arabinda K.

doi:10.1007/s00247-020-04931-7

Cited by 6 publications

(9 citation statements)

References 26 publications

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“…In abusive head trauma, the two primary imaging findings commonly identified on spinal imaging are subdural haemorrhage and spinal ligamentous injury [30,[35][36][37] (Figs. 1 and 2).…”

Section: Why and In Which Scenarios Should Whole Spine Imaging Be Per...mentioning

confidence: 99%

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Paddock

Choudhary²,

Jeanes³

et al. 2023

Pediatr Radiol

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This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed: Fracture dating—the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient. Whole spine imaging in suspected abusive head trauma—this is recommended to enable a complete assessment of the neuraxis when abusive head trauma is suspected or diagnosed, particularly in the presence of intracranial and cervical subdural haemorrhage and cervical ligamentous injury. Cranial imaging in suspected physical abuse—both computed tomography (CT) and magnetic resonance imaging (MRI) remain complimentary depending on the clinical context in which they are used with CT remaining first-line in the assessment of children with (suspected abusive) head trauma prior to an early MRI. MRI is superior in its assessment of parenchymal injury and may be employed as first-line in age appropriate asymptomatic siblings of a child with suspected physical abuse.

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“…In abusive head trauma, the two primary imaging findings commonly identified on spinal imaging are subdural haemorrhage and spinal ligamentous injury [30,[35][36][37] (Figs. 1 and 2).…”

Section: Why and In Which Scenarios Should Whole Spine Imaging Be Per...mentioning

confidence: 99%

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Paddock

Choudhary²,

Jeanes³

et al. 2023

Pediatr Radiol

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“…[1][2][3] Most infants with clinical or imaging cervical injuries have accompanying intracranial findings of AHT. [1][2][3][4][5] They likely experienced whiplash rotational accelerations with or without impact like those typically causing AHT. 3,4 The lack of typical intracranial findings of AHT in the current and 3 previous children suggests that they may have had a different injury mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] They likely experienced whiplash rotational accelerations with or without impact like those typically causing AHT. 3,4 The lack of typical intracranial findings of AHT in the current and 3 previous children suggests that they may have had a different injury mechanism. 4,5 All lacked a confession.…”

Section: Discussionmentioning

confidence: 99%

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Symptomatic Cervical Spinal Cord Injury Without Accompanying Intracranial Injury Because of Child Abuse

et al. 2022

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Although spinal ligamentous injuries and extra-axial hemorrhages are known to commonly accompany abusive head trauma (AHT), symptomatic and radiological apparent cervical spinal cord injuries are rare. Of the 16 previously reported cases, 3 such cord injuries lacked the accompanying intracranial injuries of AHT. We report an additional child who developed symptomatic central cervical cord syndrome, with accompanying cervical imaging findings, but no intracranial AHT injuries. The mechanism of trauma for this child and the other children without intracranial injury remains unclear. However, 1 additional reported child sustained similar injuries when she was held by her head and shaken. It is likely that as cervical magnetic resonance imaging becomes more common in AHT, more cases will be recognized.

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“…However, accumulating evidence of posterior ligamentous injury in the cervical spine suggests the requirement for a spine evaluation in suspicious AHT cases [ 10 , 34 ]. Moreover, spinal SDH was recently recognized as an important finding of AHT [ 22 ]. As spinal SDH is extremely rare in conventional TBI cases, the presence of spinal SDH highly suggests the possibility of AHT.…”

Section: Radiological Findingsmentioning

confidence: 99%

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective

Kwak

2022

J Korean Neurosurg Soc

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Abusive head trauma (AHT) is the most severe form of physical abuse in children. Such injury involves traumatic damage to the head and/or spine of infants and young children. The term AHT was introduced to include a wider range of injury mechanisms, such as intentional direct blow, throw, and even penetrating trauma by perpetuator(s). Currently, it is recommended to replace the former term, shaken baby syndrome, which implicates shaking as the only mechanism, with AHT to include diverse clinical and radiological manifestations. The consequences of AHT cause devastating medical, social and financial burdens on families, communities, and victims. The potential harm of AHT to the developing brain and spinal cord of the victims is tremendous. Many studies have reported that the adverse effects of AHT are various and serious, such as blindness, mental retardation, physical limitation of daily activities and even psychological problems. Therefore, appropriate vigilance for the early recognition and diagnosis of AHT is highly recommended to stop and prevent further injuries. The aim of this review is to summarize the relevant evidence concerning the early recognition and diagnosis of AHT. To recognize this severe type of child abuse early, all health care providers maintain a high index of suspicion and vigilance. Such suspicion can be initiated with careful and thorough history taking and physical examinations. Previously developed clinical prediction rules can be helpful for decision-making regarding starting an investigation when considering meaningful findings. Even the combination of biochemical markers may be useful to predict AHT. For a more confirmative evaluation, neuroradiological imaging is required to find AHT-specific findings. Moreover, timely consultation with ophthalmologists is needed to find a very specific finding, retinal hemorrhage.

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Spinal subdural hemorrhage in abusive head trauma: a pictorial review

Cited by 6 publications

References 26 publications

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Controversial aspects of imaging in child abuse: a second roundtable discussion from the ESPR child abuse taskforce

Symptomatic Cervical Spinal Cord Injury Without Accompanying Intracranial Injury Because of Child Abuse

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective

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