Inflicted Traumatic Brain Injury

Inflicted traumatic brain injury may present with otherwise unexplained seizures or with subtle neurological impairment. Evaluation should include assessment for non-traumatic etiologies including infection, thrombosis, coagulopathy, and metabolic disorders. A complete skeletal survey and retinal examination are essential components to an evaluation of suspected inflicted injury, and collaboration with child protection experts should be undertaken. Early MR imaging may be helpful for establishing the extent of injury, prognosis, and need for aggressive management to limit progression of the injury. The neurosurgeon should be one of the many clinicians talking to the family. Families respond best when Child Protection Services is involved from the start and can react more negatively if this new team is introduced days into the hospital stay.