The acute reversal sign: Comparison of medical and non-accidental injury patients

Rao, P.; Carty, Helen; Pierce, Agnes

doi:10.1016/s0009-9260(99)90845-0

Cited by 40 publications

(21 citation statements)

References 27 publications

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“…Therefore, the current study sought to compare the magnitude and time course of the concentrations of NSE, S100B and MBP after pediatric hypoxic-ischemic brain injury, iTBI and nTBI, in order to improve our understanding of the biochemical similarities and differences between them. Based on previous research in our laboratory [Berger et al, 2002 and because of the clinical, radiographic and histopathologic evidence of an important hypoxic-ischemic component to the injury in some cases of iTBI [Ewing-Cobbs et al, 2000;Johnson et al, 1995;Rao et al, 1999;Starling et al, 1995], we hypothesized that the magnitude of the increase in serum concentrations of these biomarkers would not differ between the different mechanisms of injury, but that the time course of the biomarkers after iTBI would mirror that seen after hypoxic-ischemic brain injury.…”

Section: Introductionmentioning

confidence: 98%

“…Our understanding of the injury sustained in iTBI has been provided through clinical observations [Johnson et al, 1995], confessions of perpetrators [Starling et al, 2004], radiographic data [Ewing-Cobbs et al, 2000;Rao et al, 1999] and histopathologic studies from children with fatal injuries [Geddes et al, 2001]. The clinical, radiographic and histopathologic information obtained from these sources suggests that hypoxemia may play an important role in the pathophysiology of iTBI.…”

Section: Introductionmentioning

confidence: 99%

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Serum Biomarkers after Traumatic and Hypoxemic Brain Injuries: Insight into the Biochemical Response of the Pediatric Brain to Inflicted Brain Injury

et al. 2006

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Inflicted traumatic brain injury (iTBI) involves a combination of mechanical trauma and hypoxemia. Serum biomarker concentrations may provide objective information about their relative importance to the pathophysiology of iTBI. We compared the time course of neuron-specific enolase (NSE), S100B and myelin basic protein after pediatric hypoxic-ischemic brain injury, iTBI and noninflicted TBI (nTBI). The time to reach peak concentrations of all three biomarkers was shorter after nTBI. Initial and peak S100B, initial and peak myelin basic protein and peak NSE concentrations were no different between the three groups. Initial NSE concentration was highest after nTBI. These results suggest that the biochemical response of the brain to iTBI is distinct from the response to nTBI and shares temporal similarities with hypoxic-ischemic brain injury. This may have important implications for the treatment and prognosis of children with iTBI.

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Serum Biomarkers after Traumatic and Hypoxemic Brain Injuries: Insight into the Biochemical Response of the Pediatric Brain to Inflicted Brain Injury

et al. 2006

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“…If a causal relationship between hypoxia-ischaemia associated with cardiorespiratory arrest and SDH is confirmed, the significance of SDHs seen in infants admitted with unexplained encephalopathy and who are found to have SDHs on admission brain imaging may have potentially profound medicolegal implications. So far, this association has been generated by research emanating from neuropathological sources and has not been supported by widespread clinical experience, the general literature of hypoxicischaemic encephalopathy in early life [3,4], radiological literature [5][6][7][8][9][10] and a recent multicentre multinational post-mortem (PM) examination study [11]. It is particularly pertinent that the extensive imaging literature relating to radiological manifestations of hypoxic-ischaemic injury in early life does not refer to or identify SDH as a component of the injury spectrum or as a sequela.…”

mentioning

confidence: 99%

Is there a causal relationship between the hypoxia–ischaemia associated with cardiorespiratory arrest and subdural haematomas? An observational study

Hurley

Dineen²,

Padfield³

et al. 2010

BJR

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ABSTRACT. The aim of this study was to determine the frequency of subdural haematomas (SDHs) occurring in infants presenting following atraumatic cardiorespiratory collapse. This study was a review of retrospective case notes, brain imaging and post-mortem examinations carried out in the paediatric intensive care unit (PICU) and emergency department (ED) in a tertiary paediatric centre in the UK. The study included infants and children less than 4 years old dying in the ED or admitted to the PICU after atraumatic cardiorespiratory arrest. We identified macroscopic SDHs on brain imaging or post-mortem examination. Of those children who experienced a cardiorespiratory arrest from a non-traumatic cause and met inclusion criteria, 33 presented and died in the ED and 17 were admitted to the PICU. These children had a post-mortem examination, brain imaging or both. None of these infants had a significant SDH. One child had a small clot adherent to the dura found on post-mortem and two had microscopic intradural haemorrhage, but it is unclear in each case whether this was artefact, as each had otherwise normal brains. Subdural haematoma arising in infants or young children in the context of catastrophic cardiorespiratory compromise from a non-traumatic cause was not observed.

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“…In a series of children with intracranial lesions following non-accidental trauma, a fracture was seen in only 45% of the cases and an intracranial lesion was seen in 56% of a series of patients with a fracture [15]. In Rao's series of 47 children with non-accidental injury, there was no evidence of fracture or scalp haematoma in 31 of them [16]. In a series of 87 children with skull fractures, 67 were neurologically normal [17]; 32 of them underwent brain CT and only 6 (19%) had evidence of small focal haemorrhage near the fracture.…”

Section: Skull X-raymentioning

confidence: 94%

Cranial imaging in child abuse

2001

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Serious head injury in children less than 2 years old is often the result of child abuse. The role of the different neuroimaging modalities in child abuse is reviewed. Skull X-ray and cranial CT are mandatory. Repeat or serial imaging may be necessary and brain MR imaging may contribute to the diagnostic work-up, particularly in the absence of characteristic CT findings. The radiologist plays an important role in accurately identifying non-accidental cranial trauma. The clinical presentation can be non-specific or misleading. The possibility should be considered of a combined mechanism, i.e., an underlying condition with superimposed trauma. In this context, the radiologist is in the front line to suggest the possibility of child abuse. It is therefore important to know the spectrum of, sometimes subtle, imaging findings one may encounter. Ophthalmological examination is of the greatest importance and is discussed here, because the combination of retinal hemorrhages and subdural hematoma is very suggestive of non-accidental cranial trauma.

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The acute reversal sign: Comparison of medical and non-accidental injury patients

Cited by 40 publications

References 27 publications

Serum Biomarkers after Traumatic and Hypoxemic Brain Injuries: Insight into the Biochemical Response of the Pediatric Brain to Inflicted Brain Injury

Serum Biomarkers after Traumatic and Hypoxemic Brain Injuries: Insight into the Biochemical Response of the Pediatric Brain to Inflicted Brain Injury

Is there a causal relationship between the hypoxia–ischaemia associated with cardiorespiratory arrest and subdural haematomas? An observational study

Cranial imaging in child abuse

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