Spinal subdural hemorrhage in abusive head trauma: a pictorial review

OBJECT At presentation, children who have experienced abusive head trauma (AHT) often have subdural hemorrhage (SDH) that is acute, chronic, or both. Controversy exists whether the acute SDH associated with chronic SDH results from trauma or from spontaneous rebleeding. The authors compared the clinical presentations of children with AHT and acute SDH with those having acute and chronic SDH (acute/chronic SDH). METHODS The study was a multicenter retrospective review of children who had experienced AHT during 2004–2009. The authors compared the clinical and radiological characteristics of children with acute SDH to those of children with acute/chronic SDH. RESULTS The study included 383 children with AHT and either acute SDH (n = 291) or acute/chronic SDH (n = 92). The children with acute/chronic SDH were younger, had higher initial Glasgow Coma Scale scores, fewer deaths, fewer skull fractures, less parenchymal brain injury, and fewer acute noncranial fractures than did children with acute SDH. No between-group differences were found for the proportion with retinal hemorrhages, healing noncranial fractures, or acute abusive bruises. A similar proportion (approximately 80%) of children with acute/chronic SDH and with acute SDH had retinal hemorrhages or acute or healing extracranial injures. Of children with acute/chronic SDH, 20% were neurologically asymptomatic at presentation; almost half of these children were seen for macrocephaly, and for all of them, the acute SDH was completely within the area of the chronic SDH. CONCLUSIONS Overall, the presenting clinical and radiological characteristics of children with acute SDH and acute/chronic SDH caused by AHT did not differ, suggesting that repeated abuse, rather than spontaneous rebleeding, is the etiology of most acute SDH in children with chronic SDH. However, more severe neurological symptoms were more common among children with acute SDH. Children with acute/chronic SDH and asymptomatic macrocephaly have unique risks and distinct radiological and clinical characteristics.

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Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: Perfusion abnormalities in abusive head trauma

Journal of Neuroradiology ◽

10.1016/j.neurad.2017.02.003 ◽

2017 ◽

Vol 44 (4) ◽

pp. 281-287 ◽

Cited By ~ 8

Author(s):

Alex Mun-Ching Wong ◽

Chih-Hua Yeh ◽

Ho-Ling Liu ◽

Tai-Wei Wu ◽

Kuang-Lin Lin ◽

...

Keyword(s):

Head Trauma ◽

Perfusion Imaging ◽

Arterial Spin Labeling ◽

Abusive Head Trauma ◽

Spin Labeling ◽

Subdural Hemorrhage

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Subdural hemorrhage in a cohort with cerebral sinovenous thrombosis: Application to abusive head trauma

Child Abuse & Neglect ◽

10.1016/j.chiabu.2021.105119 ◽

2021 ◽

Vol 117 ◽

pp. 105119

Author(s):

James Anderst ◽

Shannon Carpenter ◽

Terra Frazier ◽

Brian Appavu ◽

Michael Noetzel ◽

...

Keyword(s):

Head Trauma ◽

Abusive Head Trauma ◽

Subdural Hemorrhage ◽

Cerebral Sinovenous Thrombosis ◽

Sinovenous Thrombosis

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Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma

Pediatric Radiology ◽

10.1007/s00247-018-4237-2 ◽

2018 ◽

Vol 48 (13) ◽

pp. 1915-1923 ◽

Cited By ~ 2

Author(s):

Meghann M. Ronning ◽

Patrick L. Carolan ◽

Gretchen J. Cutler ◽

Richard J. Patterson

Keyword(s):

Head Trauma ◽

Abusive Head Trauma ◽

Subdural Hemorrhage ◽

Head Ct

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Venous injury in pediatric abusive head trauma: a pictorial review

Pediatric Radiology ◽

10.1007/s00247-021-05016-9 ◽

2021 ◽

Author(s):

George Koshy Vilanilam ◽

Sateesh Jayappa ◽

Shivang Desai ◽

Giulio Zuccoli ◽

Raghu H. Ramakrishnaiah ◽

...

Keyword(s):

Head Trauma ◽

Abusive Head Trauma ◽

Venous Injury ◽

Pictorial Review

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Limitations of T2*–Gradient Recalled-Echo and Susceptibility-Weighted Imaging in Characterizing Chronic Subdural Hemorrhage in Infant Survivors of Abusive Head Trauma

American Journal of Neuroradiology ◽

10.3174/ajnr.a4769 ◽

2016 ◽

Vol 37 (9) ◽

pp. 1752-1756 ◽

Cited By ~ 6

Author(s):

J.A. Cramer ◽

U.A. Rassner ◽

G.L. Hedlund

Keyword(s):

Head Trauma ◽

Abusive Head Trauma ◽

Susceptibility Weighted Imaging ◽

Subdural Hemorrhage

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Abusive head trauma: experience improves diagnosis

Neuroradiology ◽

10.1007/s00234-020-02564-z ◽

2020 ◽

Author(s):

Luciana Porto ◽

Marco Baz Bartels ◽

Jonas Zwaschka ◽

Se-Jong You ◽

Christoph Polkowski ◽

...

Keyword(s):

Head Trauma ◽

Metabolic Diseases ◽

Motor Vehicle ◽

Clinical History ◽

Abusive Head Trauma ◽

Subdural Hemorrhage ◽

Vehicle Accidents ◽

Pediatric Neuroimaging ◽

Subarachnoid Spaces ◽

Probable Diagnosis

Abstract Purpose The diagnosis of abusive head trauma (AHT) is complex and neuroimaging plays a crucial role. Our goal was to determine whether non-neuroradiologists with standard neuroradiology knowledge perform as well as neuroradiologists with experience in pediatric neuroimaging in interpreting MRI in cases of presumptive AHT (pAHT). Methods Twenty children were retrospectively evaluated. Patients had been diagnosed with pAHT (6 patients), non-abusive head trauma-NAHT (5 patients), metabolic diseases (3 patients), and benign enlargement of the subarachnoid spaces (BESS) (6 patients). The MRI was assessed blindly, i.e., no clinical history was given to the 3 non-neuroradiologists and 3 neuroradiologists from 2 different institutions. Results Blindly, neuroradiologists demonstrated higher levels of sensitivity and positive predictive value in the diagnosis of pAHT (89%) than non-neuroradiologists (50%). Neuroradiologists chose correctly pAHT as the most probable diagnosis 16 out of 18 times; in contrast, non-neuroradiologists only chose 9 out of 18 times. In our series, the foremost important misdiagnosis for pAHT was NAHT (neuroradiologists twice and non-neuroradiologists 5 times). Only victims of motor vehicle accidents were blindly misdiagnosed as pAHT. No usual household NAHT was not misdiagnosed as pAHT. Neuroradiologists correctly ruled out pAHT in all cases of metabolic diseases and BESS. Conclusion MRI in cases of suspected AHT should be evaluated by neuroradiologists with experience in pediatric neuroimaging. Neuroradiologists looked beyond the subdural hemorrhage (SDH) and were more precise in the assessment of pAHT and its differential diagnosis than non-neuroradiologists were. It seems that non-neuroradiologists mainly assess whether or not a pAHT is present depending on the presence or absence of SDH.

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Clinical Characteristics and Predictors of Poor Hospital Discharge Outcome for Young Children with Abusive Head Trauma

Journal of Clinical Medicine ◽

10.3390/jcm8030390 ◽

2019 ◽

Vol 8 (3) ◽

pp. 390 ◽

Cited By ~ 6

Author(s):

Chih-Chi Chen ◽

Po-Chuan Hsieh ◽

Carl Chen ◽

Yu-Wei Hsieh ◽

Chia-Ying Chung ◽

...

Keyword(s):

Head Trauma ◽

Head Injuries ◽

Abusive Head Trauma ◽

Older Age ◽

Subdural Hemorrhage ◽

Logistic Regression Models ◽

Poor Outcome ◽

Radiologic Findings ◽

Early Predictors ◽

Poor Outcomes

Children with abusive head trauma tend to have worse outcomes than children with accidental head trauma. However, current predictors of poor outcomes for children with abusive head trauma are still limited. We aim to use clinical data to identify early predictors of poor outcome at discharge in children with abusive head trauma. In the 10-year observational retrospective cohort study, children aged between zero and four years with abusive or accidental head trauma were recruited. Multivariate logistic regression models were applied to evaluate factors associated with poor prognosis in children with abusive head trauma. The primary outcome was mortality or a Glasgow Coma Scale (GCS) motor component score of less than 6 at discharge. A total of 292 head trauma children were included. Among them, 59 children had abusive head trauma. In comparison to children with accidental head trauma, children with abusive head trauma were younger, had more severe head injuries, and experienced a higher frequency of post-traumatic seizures. Their radiologic findings showed common presence of subdural hemorrhage, cerebral edema, and less epidural hemorrhage. They were more in need of neurosurgical intervention. In the multivariate analysis for predictors of poor outcome in children with abusive head trauma, initial GCS ≤ 5 (versus GCS > 5 with the adjusted odds ratio (OR) = 25.7, 95% confidence interval (CI) = 1.5–432.8, p = 0.024) and older age (per year with the adjusted OR = 3.3, 95% CI = 1.2–9.5, p = 0.024) were independently associated with poor outcome. These findings demonstrate the characteristic clinical differences between children with abusive and accidental head trauma. Initial GCS ≤ 5 and older age are predictive of poor outcome at discharge in children with abusive head trauma.

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