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Neuroimaging differential diagnoses to abusive head trauma

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Abstract

Trauma is the most common cause of death in childhood, and abusive head trauma is the most common cause of traumatic death and morbidity in infants younger than 1 year. The main differential diagnosis of abusive head trauma is accidental traumatic brain injury, which is usually witnessed. This paper also discusses more uncommon diagnoses such as congenital and acquired disorders of hemostasis, cerebral arteriovenous malformations and metabolic diseases, all of which are extremely rare. Diagnostic imaging including CT and MRI is very important for the distinction of non-accidental from accidental traumatic injury.

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References

  1. Duhaime AC, Gennarelli TA, Thibault LE et al (1987) The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66:409–415

    Article  CAS  PubMed  Google Scholar 

  2. Lopes NR, Eisenstein E, Williams LC (2013) Abusive head trauma in children: a literature review. J Pediatr 89:426–433

    Article  Google Scholar 

  3. Lancon JA, Haines DE, Parent AD (1998) Anatomy of the shaken baby syndrome. Anat Rec 253:13–18

    Article  CAS  PubMed  Google Scholar 

  4. Laurent-Vannier A, Nathanson M, Quiriau F et al (2011) A public hearing: ‘Shaken baby syndrome: guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff’. Guidelines issued by the Hearing Commission. Ann Phys Rehabil Med 54:600–625

    Article  CAS  PubMed  Google Scholar 

  5. Vinchon M, Defoort-Dhellemmes S, Desurmont M et al (2005) Accidental and nonaccidental head injuries in infants: a prospective study. J Neurosurg 102:380–384

    PubMed  Google Scholar 

  6. Tun K, Choudhary AK, Methratta S et al (2013) Radiological features of nonaccidental injury. J Radiol Nurs 32:3–9

    Article  Google Scholar 

  7. Zimmerman RA, Bilaniuk LT, Bruce D et al (1978) Interhemispheric acute subdural hematoma: a computed tomographic manifestation of child abuse by shaking. Neuroradiology 16:39–40

    Article  CAS  PubMed  Google Scholar 

  8. Barlow KM, Gibson RJ, McPhillips M et al (1999) Magnetic resonance imaging in acute non-accidental head injury. Acta Paediatr 88:734–740

    Article  CAS  PubMed  Google Scholar 

  9. Pierce MC, Fingarson AK (2012) Identifying abusive head trauma. Contemp Pediatr http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/news/modernmedicine/modern-medicine-feature-articles/identifying-abusive-hea. Accessed 16 Oct 2015

  10. Duhaime AC, Christian C (1999) Nonaccidental trauma. In: Choux M, Di Rocco C, Hockley A, Walker M (eds) Pediatric neurosurgery. Churchill Livingstone, London, pp 373–379

    Google Scholar 

  11. Piteau SJ, Ward MG, Barrowman NJ et al (2012) Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics 130:315–323

    Article  PubMed  Google Scholar 

  12. Kemp AM (2011) Abusive head trauma: recognition and the essential investigation. Arch Dis Child Educ Pract Ed 96:202–208

    Article  PubMed  Google Scholar 

  13. Meservy CJ, Towbin R, McLaurin RL et al (1987) Radiographic characteristics of skull fractures resulting from child abuse. AJR Am J Roentgenol 149:173–175

    Article  CAS  PubMed  Google Scholar 

  14. Hobbs CJ (1984) Skull fracture and the diagnosis of abuse. Arch Dis Child 59:246–252

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Choudhary AK, Jha B, Boal DK et al (2010) Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT? Surg Radiol Anat 32:807–816

    Article  PubMed  Google Scholar 

  16. Hobbs CJ (1989) ABC of child abuse. Fractures. BMJ 298:1015–1018

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Gean AD (1995) Pediatric trauma. In: Gean AD (ed) Imaging of head trauma. Raven, New York, pp 367–426

    Google Scholar 

  18. Geddes JF, Tasker RC, Hackshaw AK et al (2003) Dural haemorrhage in non-traumatic infant deaths: does it explain the bleeding in ‘shaken baby syndrome’? Neuropathol Appl Neurobiol 29:14–22

    Article  CAS  PubMed  Google Scholar 

  19. 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  PubMed  Google Scholar 

  20. Reece RM, Sege R (2000) Childhood head injuries: accidental or inflicted? Arch Pediatr Adolesc Med 154:11–15

    CAS  PubMed  Google Scholar 

  21. Hymel KP, Rumack CM, Hay TC et al (1997) Comparison of intracranial computed tomographic (CT) findings in pediatric abusive and accidental head trauma. Pediatr Radiol 27:743–747

    Article  CAS  PubMed  Google Scholar 

  22. Cohen RA, Kaufman RA, Myers PA et al (1986) Cranial computed tomography in the abused child with head injury. AJR Am J Roentgenol 146:97–102

    Article  CAS  PubMed  Google Scholar 

  23. Ewing-Cobbs L, Prasad M, Kramer L et al (2000) Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Childs Nerv Syst 16:25–33

    Article  CAS  PubMed  Google Scholar 

  24. Gabaeff SC (2013) Investigating the possibility and probability of perinatal subdural hematoma progressing to chronic subdural hematoma, with and without complications, in neonates, and its potential relationship to the misdiagnosis of abusive head trauma. Leg Med (Tokyo) 15:177–192

    Article  Google Scholar 

  25. Whitby EH, Griffiths PD, Rutter S et al (2004) Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet 363:846–851

    Article  CAS  PubMed  Google Scholar 

  26. Rooks VJ, Eaton JP, Ruess L et al (2008) Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. AJNR Am J Neuroradiol 29:1082–1089

    Article  CAS  PubMed  Google Scholar 

  27. Tung GA, Kumar M, Richardson RC et al (2006) Comparison of accidental and nonaccidental traumatic head injury in children on noncontrast computed tomography. Pediatrics 118:626–633

    Article  PubMed  Google Scholar 

  28. Vinchon M, Noule N, Tchofo PJ et al (2004) Imaging of head injuries in infants: temporal correlates and forensic implications for the diagnosis of child abuse. J Neurosurg 101:44–52

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  30. Gomori JM, Grossman RI, Hackney DB et al (1988) Variable appearances of subacute intracranial hematomas on high-field spin-echo MR. AJR Am J Roentgenol 150:171–178

    Article  CAS  PubMed  Google Scholar 

  31. Vezina G (2009) Assessment of the nature and age of subdural collections in nonaccidental head injury with CT and MRI. Pediatr Radiol 39:586–590

    Article  PubMed  Google Scholar 

  32. Adamsbaum C, Morel B, Ducot B et al (2014) Dating the abusive head trauma episode and perpetrator statements: key points for imaging. Pediatr Radiol 44:S578–588

    Article  PubMed  Google Scholar 

  33. Ibrahim NG, Wood J, Margulies SS et al (2012) Influence of age and fall type on head injuries in infants and toddlers. Int J Dev Neurosci 30:201–206

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gilles EE, Nelson MD Jr (1998) Cerebral complications of nonaccidental head injury in childhood. Pediatr Neurol 19:119–128

    Article  CAS  PubMed  Google Scholar 

  35. Biousse V, Suh DY, Newman NJ et al (2002) Diffusion-weighted magnetic resonance imaging in shaken baby syndrome. Am J Ophthalmol 133:249–255

    Article  PubMed  Google Scholar 

  36. Gerber P, Coffman K (2007) Nonaccidental head trauma in infants. Childs Nerv Syst 23:499–507

    Article  PubMed  Google Scholar 

  37. Ment LR, Duncan CC, Geehr R (1981) Benign enlargement of the subarachnoid spaces in the infant. J Neurosurg 54:504–508

    Article  CAS  PubMed  Google Scholar 

  38. Raul JS, Roth S, Ludes B et al (2008) Influence of the benign enlargement of the subarachnoid space on the bridging veins strain during a shaking event: a finite element study. Int J Legal Med 122:337–340

    Article  PubMed  Google Scholar 

  39. Vinchon M, Delestret I, DeFoort-Dhellemmes S et al (2010) Subdural hematoma in infants: can it occur spontaneously? Data from a prospective series and critical review of the literature. Childs Nerv Syst 26:1195–1205

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  41. Oberbauer RW (1999) Intracranial and intraspinal cysts. In: Choux M, Di Rocco C, Hockley A, Walker M (eds) Pediatric neurosurgery. Churchill Livingstone, London, pp 137–149

    Google Scholar 

  42. Girard N, Zimmerman RA (1997) Infectious and inflammatory diseases of the brain and spinal cord. In: Zimmerman RA, Gibby WA, Carmody RF (eds) Neuroimaging: clinical and physical principles. Spiringer-Verlag, New York, pp 909–950

    Google Scholar 

  43. Zimmerman RA, Wong AM, Girard N (2004) Imaging of intracranial infections. In: Scheld WM, Whitley RJ, Marra CM (eds) Infections of the central nervous system. Lippincott Williams & Wilkins, Philadelphia, pp 31–55

    Google Scholar 

  44. Jackson J, Carpenter S, Anderst J (2012) Challenges in the evaluation for possible abuse: presentations of congenital bleeding disorders in childhood. Child Abuse Negl 36:127–134

    Article  PubMed  Google Scholar 

  45. Morris AA, Hoffmann GF, Naughten ER et al (1999) Glutaric aciduria and suspected child abuse. Arch Dis Child 80:404–405

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Hoffmann GF, Kolker S (2012) Cerebral organic acid disorders and other disorders of lysine catabolism. In: Saudubray JM, van den Berghe G, Walter JH (eds) Inborn metabolic diseases: diagnosis and treatment. Springer, Berlin Heidelberg, pp 333–346

    Chapter  Google Scholar 

  47. Bacopoulou F, Henderson L, Philip SG (2006) Menkes disease mimicking non-accidental injury. Arch Dis Child 91:919

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Bierings M, Clayton P, Houwen RHJ (2012) Disorders in the transport of copper, iron, magnesium, manganese, selenium and zinc. In: Saudubray JM, van den Berghe G, Walter JH (eds) Inborn metabolic diseases: diagnosis and treatment. Springer, Berlin Heidelberg, pp 535–549

    Chapter  Google Scholar 

  49. Hill SC, Dwyer AJ, Kaler SG (2012) Cervical spine anomalies in Menkes disease: a radiologic finding potentially confused with child abuse. Pediatr Radiol 42:1301–1304

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neuroradiology, AP-HM Timone 2, 264 Boulevard Jean Moulin, 13285, Marseille cedex 05, France

    Nadine Girard, Hervé Brunel & Philippe Dory-Lautrec

  2. Aix Marseille University, UMR CNRS 7339, Marseille, France

    Nadine Girard

  3. Department of Pediatric Neurology, AP-HM Timone, Marseille, France

    Brigitte Chabrol

Authors
  1. Nadine Girard
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  2. Hervé Brunel
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  3. Philippe Dory-Lautrec
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  4. Brigitte Chabrol
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Correspondence to Nadine Girard.

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Girard, N., Brunel, H., Dory-Lautrec, P. et al. Neuroimaging differential diagnoses to abusive head trauma. Pediatr Radiol 46, 603–614 (2016). https://doi.org/10.1007/s00247-015-3509-3

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