Abstract
Aims: To review the neuroimaging of a series of infants and young children admitted to hospital with subdural haemorrhage (SDH).
Methods: Neuroradiological investigations of 74 children under 2 years of age, from South Wales and southwest England, in whom an SDH or subdural effusion had been diagnosed between 1992 and 2001, were reviewed. Two paediatric neuroradiologists blinded to the original radiological report reviewed all the relevant images.
Results: Neuroradiological review of images identified radiological features which were highly suggestive of non-accidental head injury (NAHI). Interhemispheric haemorrhages and SDHs in multiple sites or of different densities were almost exclusively seen in NAHI. MRI was more sensitive in identifying SDHs of different signal characteristics, posterior and middle cranial fossa bleeds, and parenchymal changes in the brain. CT scans, if performed with suboptimal protocols, were likely to miss small subdural bleeds.
Conclusions: Guidelines for neuroimaging in suspected NAHI are recommended. A radiologist with experience in NAHI should report or review these scans. The initial investigation should be CT, but MRI will also be necessary in most cases. Head CT should be an integral part of the skeletal survey in all infants less than 6 months of age referred for child protection investigation, and in children less than 2 years where child abuse is suspected and there are neurological signs, retinal haemorrhages, or fractures.
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Selected References
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- Alexander R. C., Schor D. P., Smith W. L., Jr Magnetic resonance imaging of intracranial injuries from child abuse. J Pediatr. 1986 Dec;109(6):975–979. doi: 10.1016/s0022-3476(86)80279-7. [DOI] [PubMed] [Google Scholar]
- Atlas S. W. MR imaging is highly sensitive for acute subarachnoid hemorrhage ... not! Radiology. 1993 Feb;186(2):319–323. doi: 10.1148/radiology.186.2.8421727. [DOI] [PubMed] [Google Scholar]
- Barlow K. M., Gibson R. J., McPhillips M., Minns R. A. Magnetic resonance imaging in acute non-accidental head injury. Acta Paediatr. 1999 Jul;88(7):734–740. doi: 10.1080/08035259950169017. [DOI] [PubMed] [Google Scholar]
- Barlow K. M., Minns R. A. Annual incidence of shaken impact syndrome in young children. Lancet. 2000 Nov 4;356(9241):1571–1572. doi: 10.1016/S0140-6736(00)03130-5. [DOI] [PubMed] [Google Scholar]
- Biousse Valérie, Suh Daniel Y., Newman Nancy J., Davis Patricia C., Mapstone Timothy, Lambert Scott R. Diffusion-weighted magnetic resonance imaging in Shaken Baby Syndrome. Am J Ophthalmol. 2002 Feb;133(2):249–255. doi: 10.1016/s0002-9394(01)01366-6. [DOI] [PubMed] [Google Scholar]
- Cohen R. A., Kaufman R. A., Myers P. A., Towbin R. B. Cranial computed tomography in the abused child with head injury. AJR Am J Roentgenol. 1986 Jan;146(1):97–102. doi: 10.2214/ajr.146.1.97. [DOI] [PubMed] [Google Scholar]
- Geddes J. F., Hackshaw A. K., Vowles G. H., Nickols C. D., Whitwell H. L. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain. 2001 Jul;124(Pt 7):1290–1298. doi: 10.1093/brain/124.7.1290. [DOI] [PubMed] [Google Scholar]
- Geddes J. F., Vowles G. H., Hackshaw A. K., Nickols C. D., Scott I. S., Whitwell H. L. Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain. 2001 Jul;124(Pt 7):1299–1306. doi: 10.1093/brain/124.7.1299. [DOI] [PubMed] [Google Scholar]
- Haseler L. J., Arcinue E., Danielsen E. R., Bluml S., Ross B. D. Evidence from proton magnetic resonance spectroscopy for a metabolic cascade of neuronal damage in shaken baby syndrome. Pediatrics. 1997 Jan;99(1):4–14. doi: 10.1542/peds.99.1.4. [DOI] [PubMed] [Google Scholar]
- Jaspan T., Griffiths P. D., McConachie N. S., Punt J. A. G. Neuroimaging for non-accidental head injury in childhood: a proposed protocol. Clin Radiol. 2003 Jan;58(1):44–53. doi: 10.1053/crad.2002.1094. [DOI] [PubMed] [Google Scholar]
- Jayawant S., Rawlinson A., Gibbon F., Price J., Schulte J., Sharples P., Sibert J. R., Kemp A. M. Subdural haemorrhages in infants: population based study. BMJ. 1998 Dec 5;317(7172):1558–1561. doi: 10.1136/bmj.317.7172.1558. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnson D. L., Boal D., Baule R. Role of apnea in nonaccidental head injury. Pediatr Neurosurg. 1995;23(6):305–310. doi: 10.1159/000120976. [DOI] [PubMed] [Google Scholar]
- Kemp A. M., Stoodley N., Cobley C., Coles L., Kemp K. W. Apnoea and brain swelling in non-accidental head injury. Arch Dis Child. 2003 Jun;88(6):472–476. doi: 10.1136/adc.88.6.472. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morris M. W., Smith S., Cressman J., Ancheta J. Evaluation of infants with subdural hematoma who lack external evidence of abuse. Pediatrics. 2000 Mar;105(3 Pt 1):549–553. doi: 10.1542/peds.105.3.549. [DOI] [PubMed] [Google Scholar]
- Rao P., Carty H., Pierce A. The acute reversal sign: comparison of medical and non-accidental injury patients. Clin Radiol. 1999 Aug;54(8):495–501. doi: 10.1016/s0009-9260(99)90845-0. [DOI] [PubMed] [Google Scholar]
- Sato Y., Yuh W. T., Smith W. L., Alexander R. C., Kao S. C., Ellerbroek C. J. Head injury in child abuse: evaluation with MR imaging. Radiology. 1989 Dec;173(3):653–657. doi: 10.1148/radiology.173.3.2813768. [DOI] [PubMed] [Google Scholar]
- Suh D. Y., Davis P. C., Hopkins K. L., Fajman N. N., Mapstone T. B. Nonaccidental pediatric head injury: diffusion-weighted imaging findings. Neurosurgery. 2001 Aug;49(2):309–320. doi: 10.1097/00006123-200108000-00011. [DOI] [PubMed] [Google Scholar]
- Zimmerman R. A., Bilaniuk L. T., Bruce D., Schut L., Uzzell B., Goldberg H. I. Computed tomography of craniocerebral injury in the abused child. Radiology. 1979 Mar;130(3):687–690. doi: 10.1148/130.3.687. [DOI] [PubMed] [Google Scholar]