![]() With respect to other variants of AHT, further features of head injury may occur, in particular, signs of blunt force (impact) trauma against the child's head such as skin lesions or skull fractures. Missing or inadequate anamnesis-that is, no trauma reported or report of just a minor trauma despite the presence of severe brain injury. No or only minimal injuries of the skin because skin bruises caused by firm grip at the arms or the thorax of the child are rare. Spinal trauma such as ligamentous injuries at the craniocervical junction, or spinal sub- or epidural hematomas. Retinal hemorrhages typically found in many locations, within several layers, disseminated, widespread from the center to the periphery, and with or without additional retinoschisis or intravitreal hemorrhage. Subdural collections with or without additional extra-axial findings such as subarachnoid hemorrhage, arachnoid tear, or bridging vein thrombosis. The shaken baby syndrome-a common variant of AHT with increasing general public awareness-is characterized by the following features that are neither obligatory nor evidentiary:Īcute encephalopathy, being the clinical expression of traumatic damage of the brain parenchyma accompanied by a wide spectrum of neurologic symptoms that depend on the intensity of the trauma. 15 Survivors showed severe disability (eg, tetraplegia, epilepsy, or blindness) in ∼34%, and moderate disability (eg, hemiplegia, memory and attention difficulties) in ∼25% of the cases. 14 Meta-analyses on the outcome revealed an average mortality rate of around 20% among children younger than 2 years of age. ![]() 5, 10 ⇓ ⇓– 13 Additionally, a high amount of underreporting has to be assumed because many cases are not identified due to subclinical courses, nonspecific symptoms, or missing medical consultation. ![]() 7 ⇓– 9ĪHT has a worldwide incidence of 14–30/100,000 live births among children younger than 1 year of age. 4 ⇓– 6 Currently, the term “abusive head trauma” (AHT) is used for any nonaccidental or inflicted head injuries in pediatrics. 1 ⇓– 3 Head injuries represent the most frequent cause of lethal outcome and mainly relate to children within their first and second years of life. In light of serious physical, psychological, and legal consequences, physical child abuse attracts increasing attention in terms of health policy and health economy. In addition to more reference data, a harmonization of terminology and methodology is urgently needed, especially with respect to age-diagnostic aspects.ĪBBREVIATIONS: AHT abusive head trauma BV bridging vein cSDH chronic subdural hematoma SDC subdural collection SDE subdural effusion SDH subdural hematoma SDEm subdural empyema SDHy subdural hygroma SDHHy subdural hematohygroma The neuroradiologic analysis and assessment of subdural collections may decisively contribute to answering differential diagnostic and forensic questions. Two problematic constellations frequently occurring during initial CT investigations are evaluated: A mixed-density subdural collection does not prove repeated trauma, and hypodense subdural collections are not synonymous with chronicity. Differential and age-diagnostic aspects are discussed and summarized by tabular and graphic overviews. The pathophysiologic background is explained. To this end, the different subdural collection entities are presented and illustrated. The present review article sheds light on subdural collections in children with abusive head trauma and aims at providing a recent knowledge base for various medical disciplines involved in diagnostic procedures and legal proceedings. A common variant of the abusive head trauma is the shaken baby syndrome. SUMMARY: Life-threatening physical abuse of infants and toddlers is frequently correlated with head injuries.
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