Accidental Head Trauma

  • Paolo Tortori-Donati
  • Andrea Rossi
  • Roberta Biancheri


The terms “birth trauma” and “perinatal trauma” refer to injuries occurring during labor or delivery [1]. Although these terms are sometimes used broadly, only the adverse effects caused primarily by mechanical factors (Table 19.1) should be considered under these headings. Perinatal mechanical insults may result in hypoxic-ischemic cerebral injury, probably secondary to disturbances of placental or cerebral blood flow [1], thus causing some overlapping between mechanical and hypoxic-ischemic injury. However, only mechanical injury will be discussed in this Chapter, whereas perinatal hypoxic-ischemic injury is discussed in Chapters 5 and 6.


Head Trauma Subdural Hematoma Epidural Hematoma Skull Fracture Axial Computerize Tomography 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Volpe JJ. Neurology of the Newborn, 4th edn. Philadelphia: W.B. Saunders, 2001.Google Scholar
  2. 2.
    Blaser S, Jay V, Becker LE, Ford-Jones EL. Neonatal brain infection. In: Rutherford M (ed) MRI of the neonatal brain. London: W.B. Saunders, 2002:201–224.Google Scholar
  3. 3.
    Poussaint TY, Moeller KK. Imaging of pediatric head trauma. Neuroimag Clin N Am 2002; 12:271–294.CrossRefGoogle Scholar
  4. 4.
    Anton J, Pineda V, Martin C, Artigas J, Rivera J. Posttraumatic subgaleal hematoma: a case report and review of the literature. Pediatr Emerg Care 1999; 15:347–349.PubMedCrossRefGoogle Scholar
  5. 5.
    Barkovich AJ. Pediatric Neuroimaging, 3rd edn. Philadelphia: Lippincott Williams & Wilkins, 2000.Google Scholar
  6. 6.
    Goodwin MD, Persing JA, Duncan CC, Shin JH. Spontaneously infected cephalohematoma: case report and review of the literature. J Craniofac Surg 2000; 11:371–375.CrossRefPubMedGoogle Scholar
  7. 7.
    Currarino G. Occipital osteodiastasis: presentation of four cases and review of the literature. Pediatr Radiol 2000; 30:823–829.CrossRefPubMedGoogle Scholar
  8. 8.
    Graham DI, Genarelli TA. Trauma. In: Graham DI, Lantos PL (eds) Greenfield’s Neuropathology, 6th edn. London: Arnold, 1997:197–262.Google Scholar
  9. 9.
    Ewing-Cobbs L, Kramer L, Prasad M, Canales DN, Louis PT, Fletcher JM, Vollero H, Landry SH, Cheung K. Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children. Pediatrics 1998; 102(2 Pt 1):300–307.CrossRefPubMedGoogle Scholar
  10. 10.
    Ewing-Cobbs L, Prasad M, Kramer L, Louis PT, Baumgartner J, Fletcher JM, Alpert B. Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Childs Nerv Syst 2000; 16:25–33.CrossRefPubMedGoogle Scholar
  11. 11.
    Parizel PM, Oszarlak O. Imaging of Craniocerebral Trauma. CD-ROM. Lasion Europe 1999.Google Scholar
  12. 12.
    Rothman SM, Olney JW. Glutamate and the pathophysiology of hypoxic-ischemic brain damage. Ann Neurol 1986; 19:105–111.CrossRefPubMedGoogle Scholar
  13. 13.
    Rothman SM, Olney JW. Excitoxicity and the NMDA receptor. Trends Neurosci 1987; 10:299–302.CrossRefGoogle Scholar
  14. 14.
    Chen CY, Zimmerman RA, Rorke LB. Neuroimaging in child abuse: a mechanism-based approach. Neuroradiology 1999; 41:711–722.CrossRefPubMedGoogle Scholar
  15. 15.
    Barlow KM, Gibson RJ, McPhillips M, Minns RA. Magnetic resonance imaging in acute nonaccidental head injury. Acta Paediatr 1999; 88:734–740.CrossRefPubMedGoogle Scholar
  16. 16.
    Osborn AG. Diagnostic Neuroradiology. St. Louis: Mosby Year Book, 1994.Google Scholar
  17. 17.
    McDaniel T. Head and brain trauma. In: Zimmerman RA, Gibby WA, Carmody RF (eds) Neuroimaging. Clinical and Physical Principles. New York: Springer-Verlag, 2000:699–729.Google Scholar
  18. 18.
    Duhaime AC, Alario AJ, Lewander WJ, Schut L, Sutton LN, Seidl TS, Nudelman S, Budenz D, Hertle R, Tsiaras W, Loporchio S. Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 1992; 90:179–185.PubMedGoogle Scholar
  19. 19.
    Bruce DA. Imaging after head trauma: why, when and which. Childs Nerv Syst 2000; 16:755–759.CrossRefPubMedGoogle Scholar
  20. 20.
    Singer MB, Atlas SW, Drayer BP. Subarachnoid space disease: diagnosis with fluid-attenuated inversion-recovery MR imaging and comparison with gadolinium-enhanced spin-echo MR imaging-blinded reader study. Radiology 1998; 208:417–422.PubMedGoogle Scholar
  21. 21.
    Noguchi K, Ogawa T, Seto H, Inugami A, Hadeishi H, Fujita H, Hatazawa J, Shimosegawa E, Okudera T, Uemura K. Subacute and chronic subarachnoid hemorrhage: diagnosis with fluid-attenuated inversion-recovery MR imaging. Radiology 1997; 203:257–262.PubMedGoogle Scholar
  22. 22.
    American Academy of Pediatrics. Section on Radiology. Diagnostic imaging of child abuse. Pediatrics 2000; 105:1345–1348.CrossRefGoogle Scholar
  23. 23.
    Chien D, Kwong KK, Gress DR, Buonanno FS, Buxton RB, Rosen BR. MR diffusion imaging of cerebral infarction in humans. AJNR Am J Neuroradiol 1992; 13:1097–1102.PubMedGoogle Scholar
  24. 24.
    Cowan FM, Pennock JM, Hanrahan JD, Manji KP, Edwards AD. Early detection of cerebral infarction and hypoxicischemic encephalopathy in neonates using diffusion-weighted magnetic resonance imaging. Neuropediatrics 1994; 25:172–174.CrossRefPubMedGoogle Scholar
  25. 25.
    Rugg-Gunn FJ, Symms MR, Barker GJ, Greenwood R, Duncan JS. Diffusion imaging shows abnormalities after blunt head trauma when conventional magnetic resonance imaging is normal. J Neurol Neurosurg Psych 2001; 70:530–533.CrossRefGoogle Scholar
  26. 26.
    Wieshmann UC, Summs MR, Clark CA, Lemieux L, Parker GJ, Barker GJ, Shorvon SD. Blunt-head trauma associated with widespread water-diffusion changes. Lancet 1999; 353:1242–1243.CrossRefPubMedGoogle Scholar
  27. 27.
    Sutton LN, Wang Z, Duhaime AC, Costarino D, Sauter R, Zimmerman R. Tissue lactate in pediatric head trauma: a clinical study using 1H NMR spectroscopy. Pediatr Neurosurg 1995; 22:81–87.CrossRefPubMedGoogle Scholar
  28. 28.
    Friedman SD, Brooks WM, Jung RE, Chiulli SJ, Sloan JH, Montoya BT, Hart BL, Yeo RA. Quantitative proton MRS predicts outcome after traumatic brain injury. Neurology 1999; 52:1384–1391.PubMedGoogle Scholar
  29. 29.
    Friedman SD, Brooks WM, Jung RE, Hart BL, Yeo RA. Proton MR spectroscopic findings correspond to neuropsychological function in traumatic brain injury. AJNR Am J Neuroradiol 1998; 19:1879–1885.PubMedGoogle Scholar
  30. 30.
    Holshouser BA, Ashwal S, Luh GY, Shu S, Kahlon S, Auld KL, Tomasi LG, Perkin RM, Hinshaw DB Jr. Proton MR spectroscopy after acute central nervous system injury: outcome prediction in neonates, infants, and children. Radiology 1997; 202:487–496.PubMedGoogle Scholar
  31. 31.
    Ricci R, Barbarella G, Musi P, Boldrini P, Trevisan C, Basaglia N. Localised proton MR spectroscopy of brain metabolism changes in vegetative patients. Neuroradiology 1997; 39:313–319.CrossRefPubMedGoogle Scholar
  32. 32.
    Harwood-Nash DC, Hendrick EB, Hudson AR. The significance of skull fractures in children. A study of 1,187 patients. Radiology 1971; 101:151–156.PubMedGoogle Scholar
  33. 33.
    [No authors listed]. The management of minor closed head injury in children. Committee on Quality Improvement, American Academy of Pediatrics. Commission on Clinical Policies and Research, American Academy of Family Physicians. Pediatrics 1999; 104:1407–1415.Google Scholar
  34. 34.
    Schutzman SA, Barnes P, Duhaime AC, Greenes D, Homer C, Jaffe D, Lewis RJ, Luerssen TG, Schunk J. Evaluation and management of children younger than 2 years old with apparently minor head trauma: proposed guidelines. Pediatrics 2001; 107:983–993.CrossRefPubMedGoogle Scholar
  35. 35.
    Lloyd DA, Carty H, Patterson M, Butcher CK, Roe D. Predictive value of skull radiography for intracranial injury in children with blunt head injury. Lancet 1997; 349:821–824.CrossRefPubMedGoogle Scholar
  36. 36.
    Quayle KS, Jaffe DM, Kuppermann N, Kaufman BA, Lee BC, Park TS, McAlister WH. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics 1997; 99:E11.CrossRefPubMedGoogle Scholar
  37. 37.
    Naim-Ur-Rahman, Jamjoom Z, Jamjoom A, Murshid WR. Growing skull fractures: classification and management. Br J Neurosurg 1994; 8:667–679.CrossRefPubMedGoogle Scholar
  38. 38.
    Muhonen MG, Piper JG, Menezes AH. Pathogenesis and treatment of growing skull fractures. Surg Neurol 1995; 43:367–372.CrossRefPubMedGoogle Scholar
  39. 39.
    Kutlay M, Demircan N, Akin ON, Basekim C. Untreated growing cranial fractures detected in late stage. Neurosurgery 1998; 43:72–76.CrossRefPubMedGoogle Scholar
  40. 40.
    Winston K, Beatty RM, Fisher EG. Consequences of dural defects acquired in infancy. J Neurosurg 1983; 59:839–846.CrossRefPubMedGoogle Scholar
  41. 41.
    Papaefthymiou G, Oberbauer R, Pendl G. Craniocerebral birth trauma caused by vacuum extraction: a case of growing skull fracture as a perinatal complication. Childs Nerv Syst 1996; 12:117–120.CrossRefPubMedGoogle Scholar
  42. 42.
    Tandon PN, Banerji AK, Bhatia R, Goulatiq RK. Craniocerebral erosion (growing fracture of the skull in children). Acta Neurochir 1987; 88:1–9.CrossRefGoogle Scholar
  43. 43.
    Kashiwagi S, Abiko S, Aoki H. Growing skull fracture in childhood. Surg Neurol 1986; 26:63–66.CrossRefPubMedGoogle Scholar
  44. 44.
    Rothman L, Rose JS, Laster DW, Quencer R, Tenner M. The spectrum of growing skull fractures in children. Pediatrics 1976; 57:26–31.PubMedGoogle Scholar
  45. 45.
    Dharker SR, Bhargava N. Bilateral epidural hematoma. Acta Neurochir 1991; 110:29–32.CrossRefGoogle Scholar
  46. 46.
    Mohanty A, Sastry Kolluri VR, Subbakrishna DK, Satish S, Chandra Mouli BA, Das BS. Prognosis of extradural hematomas in children. Pediatr Neurosurg 1995; 23:57–63.CrossRefPubMedGoogle Scholar
  47. 47.
    Dhellemmes P, Lejeune JP, Christiaens JL, Combelles G. Traumatic extradural hematomas in infancy and childhood: experience with 144 cases. J Neurosurg 1985; 62:861–864.CrossRefPubMedGoogle Scholar
  48. 48.
    Zimmerman RA. Examination of head injury: supratentorial. In: Taveras J, Ferrucci J (eds) Radiology-Diagnosis, Imaging, Intervention. Philadelphia: JB Lippincott, 1992:1–18.Google Scholar
  49. 49.
    Kraus JF, Fife D, Conroy C. Pediatric brain injuries: the nature, clinical course, and early outcomes in a defined United States population. Pediatrics 1987; 79:501–508.PubMedGoogle Scholar
  50. 50.
    Woodcock RJ, Davis PC, Hopkins KL. Imaging of head trauma in infancy and childhood. Semin Ultrasound CT MR 2001; 22:162–182.CrossRefPubMedGoogle Scholar
  51. 51.
    Papasian NC, Frim DM. A theoretical model of benign external hydrocephalus that predicts a predisposition towards extra-axial hemorrhage after minor head trauma. Pediatr Neurosurg 2000; 33:188–193.CrossRefPubMedGoogle Scholar
  52. 52.
    Gentry LR. Head trauma. In: Atlas SW (ed) Magnetic Resonance Imaging of the Brain and Spine, 2nd edn. Philadelphia: Lippincott-Raven, 1996:611–647.Google Scholar
  53. 53.
    Grossman RI, Gomori JM, Goldberg HI, Hackney DB, Atlas SW, Kemp SS, Zimmerman RA, Bilaniuk LT. MR imaging of hemorrhagic conditions of the head and neck. Radiographics. 1988; 8:441–454.PubMedGoogle Scholar
  54. 54.
    Triulzi F, Baldoli C, Parazzini C. Patologia vascolare, infettiva e traumatica cranio-encefalica. In: Dal Pozzo G (ed) Compendio di Risonanza Magnetica. Cranio e Rachide. Turin: UTET, 2001:1191–1222.Google Scholar
  55. 55.
    Orrison WW Jr, Moore K. Neuroimaging of head trauma. In: Orrison WW Jr (ed) Neuroimaging. Philadelphia: W.B. Saunders, 2000:884–915.Google Scholar
  56. 56.
    Gentry LR, Thompson B, Godersky JC. Trauma to the corpus callosum: MR features. AJNR Am J Neuroradiol 1988; 9:1129–1138.PubMedGoogle Scholar
  57. 57.
    Holburn AHS. The mechanism of brain injuries. Br Med Bull 1945; 3:147–149.Google Scholar
  58. 58.
    Hadley MN, Sonntag VKH, Rekate HL, Murphy A. The infant whiplash-shake injury syndrome: a clinical and pathological study. Neurosurgery 1989; 24:536–540.CrossRefPubMedGoogle Scholar
  59. 59.
    Gentry LR, Godersky JC, Thompson B. MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. AJNR Am J Neuroradiol 1988; 9:101–110.Google Scholar
  60. 60.
    Adams JH, Graham DI, Murray LS, Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol 1982; 12:557–563.CrossRefPubMedGoogle Scholar
  61. 61.
    Parizel PM, Ozsarlak, Van Goethem JW, van den Hauwe L, Dillen C, Verlooy J, Cosyns P, De Schepper AM. Imaging findings in diffuse axonal injury after closed head trauma. Eur Radiol 1998; 8:960–965.CrossRefPubMedGoogle Scholar
  62. 62.
    Zimmerman RA, Bilaniuk LT, Gennarelli T. Computed tomography of shearing injuries of the cerebral white matter. Radiology 1978; 127:393–396.PubMedGoogle Scholar
  63. 63.
    Hammoud DA, Wasserman BA. Diffuse axonal injuries: pathophysiology and imaging. Neuroimaging Clin N Am 2002; 12:205–216.CrossRefPubMedGoogle Scholar
  64. 64.
    Liu AY, Maldjian JA, Bagley LJ, Sinson GP, Grossman RI. Traumatic brain injury: diffusion weighted MR imaging findings. AJNR Am J Neuroradiol 1999, 20:1636–1641.PubMedGoogle Scholar
  65. 65.
    Condon B, Oluoch-Olunya D, Hadley D, Teasdale F, Wagstaff A. Early 1H magnetic resonance spectroscopy of acute head injury: four cases. J Neurotrauma 1998; 15:563–571.CrossRefPubMedGoogle Scholar
  66. 66.
    Brooks WM, Friedman SD, Gasparovic C. Magnetic resonance spectroscopy in traumatic brain injury. J Head Trauma Rehabil 2001; 16:149–164.CrossRefPubMedGoogle Scholar
  67. 67.
    Brooks WM, Stidley CA, Petropoulos H, Jung RE, Weers DC, Friedman SD, Barlow MA, Sibbitt WL Jr, Yeo RA. Metabolic and cognitive response to human traumatic brain injury: a quantitative proton magnetic resonance study. J Neurotrauma 2000; 17:629–640.CrossRefPubMedGoogle Scholar
  68. 68.
    Sharples PM, Matthews DS, Eyre JA. Cerebral blood flow and metabolism in children with severe head injuries. Part 2: cerebrovascular resistance and its determinants. J Neurol Neursurg Psych 1995; 58:153–159.CrossRefGoogle Scholar
  69. 69.
    Ozgun B, Castillo M. Basal ganglia hemorrhage related to lightning strike. AJNR Am J Neuroradiol 1995; 16:1370–1371.PubMedGoogle Scholar
  70. 70.
    Johnson PL, Eckard DA, Chason DP, Brecheisen MA, Batnitzky S. Imaging of acquired cerebral herniations. Neuroimag Clin N Am 2002; 12:217–228.CrossRefGoogle Scholar
  71. 71.
    Bernal-Sprekelsen M, Bleda-Vazquez C, Carrau RL. Ascending meningitis secondary to traumatic cerebrospinal fluid leaks. Am J Rhinol 2000; 14:257–259.CrossRefPubMedGoogle Scholar
  72. 72.
    El Gammal T, Sobol W, Wadlington VR, Sillers MJ, Crews C, Fisher WS 3rd, Lee JY. Cerebrospinal fluid fistula: detection with MR cisternography. AJNR Am J Neuroradiol 1998; 19:627–631.PubMedGoogle Scholar
  73. 73.
    Shetty PG, Shroff MM, Sahani DV, Kirtane MV. Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula. AJNR Am J Neuroradiol 1998; 19:633–639.PubMedGoogle Scholar
  74. 74.
    Jayakumar PN, Kovoor JM, Srikanth SG, Praharaj SS. 3D steady-state MR cisternography in CSF rhinorrhoea. Acta Radiol 2001; 42:582–584.CrossRefPubMedGoogle Scholar
  75. 75.
    Domengie F, Cottier JP, Lescanne E, Aesch B, Vinikoff-Sonier C, Gallas S, Herbreteau D. [Management of cerebrospinal fluid fistulae: physiopathology, imaging and treatment]. J Neuroradiol 2004; 31:47–59.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • Paolo Tortori-Donati
    • 1
  • Andrea Rossi
    • 1
  • Roberta Biancheri
    • 1
  1. 1.Department of Pediatric NeuroradiologyG. Gaslini Children’s Research HospitalGenoaItaly

Personalised recommendations