Background: Inflicted head injury is a major cause of infant morbidity and mortality. The extent of traumatic brain injury in infants is often best characterized by diffusion weighted magnetic resonance imaging. In this cases series we describe four infants aged 6-19 months, with small unilateral subdural hematomas secondary to abusive head trauma accompanied by extensive areas of restricted diffusion weighted imaging isolated to the cerebral white matter. Methods: Retrospective, single-centre case series of four children with small unilateral subdural hematomas with early and delayed MR imaging with diffusion weighted imaging. Results: In three cases there was acute diffusion restriction ispilateral to the subdural, while in one case diffusion restriction was present bilaterally. All patients had multiple seizures and bilateral multilayered retinal hemorrhages. After non-surgical treatment, all patients survived albeit with significant motor and cognitive deficits and significant cortical atrophy on long-term followup imaging. Conclusions: These four cases highlight that relatively small subdural hematomas following child abuse can manifest with extensive white matter injury only evident at early stages with diffusion weighted imaging. We propose that selective white matter injury as a result of either reperfusion or axonal degeneration in response to the initial insult accounts for this novel pattern of infantile traumatic brain injury.
High angular resolution diffusion-weighted imaging in mild traumatic brain injury
