Skip to main content
SpringerLink
Log in

Imaging findings in abusive head trauma (AHT)

  • Review
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Brain imaging plays a key role in accurately identifying abusive head trauma (AHT). An exact and rapid diagnosis is needed due to the extreme severity of AHT, since there is a risk of neurological sequelae and potentially fatal recurrence. Several medical specialists will work collaboratively to detect and confirm abuse in children: the radiologist has a leading role in this approach. This article describes the most common neuro-imaging patterns of AHT, including extra axial, intra axial, bony, and ligamentous lesions, with a special focus on the dating issue and the differential diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Availability of data and material

Not applicable: no datasets were generated during this study.

References

  1. Adamsbaum C, Méjean N, Merzoug V, Rey-Salmon C (2010) How to explore and report children with suspected non-accidental trauma. Pediatr Radiol 40:932–938

    Article  Google Scholar 

  2. Choudhary AK et al (2018) Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48:1048–1065

    Article  Google Scholar 

  3. Blangis F et al (2021) Variations in guidelines for diagnosis of child physical abuse in high-income countries: a systematic review. JAMA Netw Open 4:e2129068

    Article  Google Scholar 

  4. Gunda D, Cornwell BO, Dahmoush HM, Jazbeh S, Alleman AM (2019) Pediatric central nervous system imaging of nonaccidental trauma: beyond subdural hematomas. Radiographics 39:213–228

    Article  Google Scholar 

  5. Fanconi M, Lips U (2010) Shaken baby syndrome in Switzerland: results of a prospective follow-up study, 2002–2007. Eur J Pediatr 169:1023–1028

    Article  Google Scholar 

  6. Silvera VM et al (2014) Retroclival collections associated with abusive head trauma in children. Pediatr Radiol 44:621–631

    Article  Google Scholar 

  7. Adamsbaum C, Rambaud C (2012) Abusive head trauma: don’t overlook bridging vein thrombosis. Pediatr Radiol 42:1298–1300

    Article  Google Scholar 

  8. Vilanilam GK et al (2021) Venous injury in pediatric abusive head trauma: a pictorial review. Pediatr Radiol 51:918–926

    Article  Google Scholar 

  9. Hahnemann ML et al (2015) Imaging of bridging vein thrombosis in infants with abusive head trauma: the “Tadpole Sign.” Eur Radiol 25:299–305

    Article  Google Scholar 

  10. Ronning MM, Carolan PL, Cutler GJ, Patterson RJ (2018) Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma. Pediatr Radiol 48:1915–1923

    Article  Google Scholar 

  11. Zimmerman RA, Bilaniuk LT, Farina L (2007) Non-accidental brain trauma in infants: diffusion imaging, contributions to understanding the injury process. J Neuroradiol 34:109–114

    Article  CAS  Google Scholar 

  12. Vázquez E et al (2014) Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging? Pediatr Radiol 44:589–603

    Article  Google Scholar 

  13. Oates AJ, Sidpra J, Mankad K (2021) Parenchymal brain injuries in abusive head trauma. Pediatr Radiol 51:898–910

    Article  Google Scholar 

  14. Palifka LA, Frasier LD, Metzger RR, Hedlund GL (2016) Parenchymal brain laceration as a predictor of abusive head trauma. Am J Neuroradiol 37:163–168

    Article  CAS  Google Scholar 

  15. Kemp AM et al (2008) Patterns of skeletal fractures in child abuse: systematic review. BMJ 337:a1518–a1518

    Article  Google Scholar 

  16. Meservy C, Towbin R, McLaurin R, Myers P, Ball W (1987) Radiographic characteristics of skull fractures resulting from child abuse. Am J Roentgenol 149:173–175

    Article  CAS  Google Scholar 

  17. Idriz S, Patel JH, Ameli Renani S, Allan R, Vlahos I (2015) CT of normal developmental and variant anatomy of the pediatric skull: distinguishing trauma from normality. Radiographics 35:1585–1601

    Article  Google Scholar 

  18. Choudhary AK, Ishak R, Zacharia TT, Dias MS (2014) Imaging of spinal injury in abusive head trauma: a retrospective study. Pediatr Radiol 44:1130–1140

    Article  Google Scholar 

  19. Haq I, Jayappa S, Desai SK, Ramakrishnaiah R, Choudhary AK (2021) Spinal ligamentous injury in abusive head trauma: a pictorial review. Pediatr Radiol 51:971–979

    Article  Google Scholar 

  20. Garcia-Pires F, Jayappa S, Desai S, Ramakrishnaiah RH, Choudhary AK (2021) Spinal subdural hemorrhage in abusive head trauma: a pictorial review. Pediatr Radiol 51:980–990

    Article  Google Scholar 

  21. Kadom N et al (2014) Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. Pediatr Radiol 44:839–848

    Article  Google Scholar 

  22. Wittschieber D, Karger B, Pfeiffer H, Hahnemann ML (2018) Understanding subdural collections in pediatric abusive head trauma. Am J Neuroradiol ajnr;ajnr.A5855v1. https://doi.org/10.3174/ajnr.A5855

  23. Dias MS, Thamburaj K (2021) Neuroradiologic timing of intracranial hemorrhage in abusive head trauma. Pediatr Radiol 51:911–917

    Article  Google Scholar 

  24. Girard N, Brunel H, Dory-Lautrec P, Chabrol B (2016) Neuroimaging differential diagnoses to abusive head trauma. Pediatr Radiol 46:603–614

    Article  Google Scholar 

  25. Bartoli M et al (2022) Is bridging vein rupture/thrombosis associated with subdural hematoma at birth? Pediatr Radiol. https://doi.org/10.1007/s00247-021-05255-w

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Radiology Department, AP-HP, Bicêtre Hospital, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    Inès Mannes, Cyrine Drissi & Catherine Adamsbaum

  2. Faculty of Medicine, Paris-Saclay University, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France

    Catherine Adamsbaum

Authors
  1. Inès Mannes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cyrine Drissi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Catherine Adamsbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design: Dr Inès Mannes and Prof Adamsbaum. Drafting of the manuscript: Dr Inès Mannes. Critical revision of the manuscript: All authors. All authors attest that they meet the current International Committee of Medical Journal Editors (ICMJE) criteria for Authorship.

Corresponding author

Correspondence to Inès Mannes.

Ethics declarations

Informed consent

The authors declare that this review does not contain any personal information that could lead to the identification of the patients.

Consent for publication

The authors give consent for publication upon acceptance.

Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article. Prof. Catherine Adamsbaum is judicial expert in the Court of Appeal of Paris and in the Supreme Court. Experts in France are independent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mannes, I., Drissi, C. & Adamsbaum, C. Imaging findings in abusive head trauma (AHT). Childs Nerv Syst 38, 2325–2334 (2022). https://doi.org/10.1007/s00381-022-05672-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-022-05672-8

Keywords

Search

Navigation