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Pediatrics
Diagnosis
Brain
Traumatic and Vascular Lesions
Abusive Head Trauma
Abusive Head Trauma
Luke L. Linscott, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Nonaccidental trauma (NAT), abusive head trauma (AHT)
              • Nonaccidental head injury (NAHI), shaken baby syndrome (SBS)

            • Synonyms

              • Battered child syndrome, whiplash shaken infant syndrome, trauma-X, Caffey-Kempe syndrome
              • Multiple alternate titles have been suggested in attempt to minimize accusatory labeling in clinical setting
                • May do more harm than good by causing confusion & hampering communication

            • Definitions

              • Traumatic injury inflicted on infants & children by adults
                • This discussion centers on head injury

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      • Reporting Tips

                                        Selected References

                                        1. Berger RP et al: Implementation of a brain injury screen MRI for infants at risk for abusive head trauma. Pediatr Radiol. 50(1):75-82, 2020
                                        2. Orman G et al: MRI findings in pediatric abusive head trauma: a review. J Neuroimaging. 30(1):15-27, 2020
                                        3. Rabbitt AL et al: Characteristics associated with spine injury on magnetic resonance imaging in children evaluated for abusive head trauma. Pediatr Radiol. 50(1):83-97, 2020
                                        4. Gencturk M et al: Various cranial and orbital imaging findings in pediatric abusive and non-abusive head trauma, and relation to outcomes. Clin Neuroradiol. 29(2):253-61, 2019
                                        5. Kralik SF et al: Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma. Neuroradiology. 61(1):81-7, 2019
                                        6. Mankad K et al: The neuroimaging mimics of abusive head trauma. Eur J Paediatr Neurol. 23(1):19-30, 2019
                                        7. Silverman LB et al: Cytotoxic edema in pediatric abusive head trauma: adopting a common nomenclature. J Neuroimaging. 29(2):272-3, 2019
                                        8. Thamburaj K et al: Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma. Pediatr Radiol. 49(2):210-6, 2019
                                        9. Wittschieber D et al: Understanding subdural collections in pediatric abusive head trauma. AJNR Am J Neuroradiol. 40(3):388-95, 2019
                                        10. Choudhary AK et al: Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol. 48(8):1048-65, 2018
                                        11. Ronning MM et al: Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma. Pediatr Radiol. 48(13):1915-23, 2018
                                        12. Teixeira SR et al: Ocular and intracranial MR imaging findings in abusive head trauma. Top Magn Reson Imaging. 27(6):503-14, 2018
                                        13. Kralik SF et al: Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients. Pediatr Radiol. 47(8):942-51, 2017
                                        14. Wong AM et al: Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: perfusion abnormalities in abusive head trauma. J Neuroradiol. 44(4):281-7, 2017
                                        15. Wright JN: CNS Injuries in abusive head trauma. AJR Am J Roentgenol. 28:1-11, 2017
                                        16. Cramer JA et al: Limitations of T2*-gradient recalled-echo and susceptibility-weighted imaging in characterizing chronic subdural hemorrhage in infant survivors of abusive head trauma. AJNR Am J Neuroradiol. 37(9):1752-6, 2016
                                        17. Girard N et al: Neuroimaging differential diagnoses to abusive head trauma. Pediatr Radiol. 46(5):603-14, 2016
                                        18. Palifka LA et al: Parenchymal brain laceration as a predictor of abusive head trauma. AJNR Am J Neuroradiol. 37(1):163-8, 2016
                                        19. Choudhary AK et al: Venous injury in abusive head trauma. Pediatr Radiol. 45(12):1803-13, 2015
                                        20. Cowley LE et al: Validation of a prediction tool for abusive head trauma. Pediatrics. 136(2):290-8, 2015
                                        21. Hahnemann ML et al: Imaging of bridging vein thrombosis in infants with abusive head trauma: the "tadpole sign". Eur Radiol. 25(2):299-305, 2015
                                        22. Rambaud C: Bridging veins and autopsy findings in abusive head trauma. Pediatr Radiol. 45(8):1126-31, 2015
                                        23. Wittschieber D et al: Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications. AJNR Am J Neuroradiol. 36(3):432-9, 2015
                                        24. Adamsbaum C et al: Dating the abusive head trauma episode and perpetrator statements: key points for imaging. Pediatr Radiol. 44 Suppl 4:S578-88, 2014
                                        25. Binenbaum G et al: The eye in child abuse: key points on retinal hemorrhages and abusive head trauma. Pediatr Radiol. 44 Suppl 4:S571-7, 2014
                                        26. Case ME: Distinguishing accidental from inflicted head trauma at autopsy. Pediatr Radiol. 44 Suppl 4:S632-40, 2014
                                        27. Nadarasa J et al: Update on injury mechanisms in abusive head trauma--shaken baby syndrome. Pediatr Radiol. 44 Suppl 4:S565-70, 2014
                                        28. Roach JP et al: Head injury pattern in children can help differentiate accidental from non-accidental trauma. Pediatr Surg Int. 30(11):1103-6, 2014
                                        29. Vázquez E et al: Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging? Pediatr Radiol. 44 Suppl 4:S589-603, 2014
                                        30. Piteau SJ et al: Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics. 130(2):315-23, 2012
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Nonaccidental trauma (NAT), abusive head trauma (AHT)
                                                    • Nonaccidental head injury (NAHI), shaken baby syndrome (SBS)

                                                  • Synonyms

                                                    • Battered child syndrome, whiplash shaken infant syndrome, trauma-X, Caffey-Kempe syndrome
                                                    • Multiple alternate titles have been suggested in attempt to minimize accusatory labeling in clinical setting
                                                      • May do more harm than good by causing confusion & hampering communication

                                                  • Definitions

                                                    • Traumatic injury inflicted on infants & children by adults
                                                      • This discussion centers on head injury

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Image Interpretation Pearls

                                                                            • Reporting Tips

                                                                              Selected References

                                                                              1. Berger RP et al: Implementation of a brain injury screen MRI for infants at risk for abusive head trauma. Pediatr Radiol. 50(1):75-82, 2020
                                                                              2. Orman G et al: MRI findings in pediatric abusive head trauma: a review. J Neuroimaging. 30(1):15-27, 2020
                                                                              3. Rabbitt AL et al: Characteristics associated with spine injury on magnetic resonance imaging in children evaluated for abusive head trauma. Pediatr Radiol. 50(1):83-97, 2020
                                                                              4. Gencturk M et al: Various cranial and orbital imaging findings in pediatric abusive and non-abusive head trauma, and relation to outcomes. Clin Neuroradiol. 29(2):253-61, 2019
                                                                              5. Kralik SF et al: Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma. Neuroradiology. 61(1):81-7, 2019
                                                                              6. Mankad K et al: The neuroimaging mimics of abusive head trauma. Eur J Paediatr Neurol. 23(1):19-30, 2019
                                                                              7. Silverman LB et al: Cytotoxic edema in pediatric abusive head trauma: adopting a common nomenclature. J Neuroimaging. 29(2):272-3, 2019
                                                                              8. Thamburaj K et al: Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma. Pediatr Radiol. 49(2):210-6, 2019
                                                                              9. Wittschieber D et al: Understanding subdural collections in pediatric abusive head trauma. AJNR Am J Neuroradiol. 40(3):388-95, 2019
                                                                              10. Choudhary AK et al: Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol. 48(8):1048-65, 2018
                                                                              11. Ronning MM et al: Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma. Pediatr Radiol. 48(13):1915-23, 2018
                                                                              12. Teixeira SR et al: Ocular and intracranial MR imaging findings in abusive head trauma. Top Magn Reson Imaging. 27(6):503-14, 2018
                                                                              13. Kralik SF et al: Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients. Pediatr Radiol. 47(8):942-51, 2017
                                                                              14. Wong AM et al: Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: perfusion abnormalities in abusive head trauma. J Neuroradiol. 44(4):281-7, 2017
                                                                              15. Wright JN: CNS Injuries in abusive head trauma. AJR Am J Roentgenol. 28:1-11, 2017
                                                                              16. Cramer JA et al: Limitations of T2*-gradient recalled-echo and susceptibility-weighted imaging in characterizing chronic subdural hemorrhage in infant survivors of abusive head trauma. AJNR Am J Neuroradiol. 37(9):1752-6, 2016
                                                                              17. Girard N et al: Neuroimaging differential diagnoses to abusive head trauma. Pediatr Radiol. 46(5):603-14, 2016
                                                                              18. Palifka LA et al: Parenchymal brain laceration as a predictor of abusive head trauma. AJNR Am J Neuroradiol. 37(1):163-8, 2016
                                                                              19. Choudhary AK et al: Venous injury in abusive head trauma. Pediatr Radiol. 45(12):1803-13, 2015
                                                                              20. Cowley LE et al: Validation of a prediction tool for abusive head trauma. Pediatrics. 136(2):290-8, 2015
                                                                              21. Hahnemann ML et al: Imaging of bridging vein thrombosis in infants with abusive head trauma: the "tadpole sign". Eur Radiol. 25(2):299-305, 2015
                                                                              22. Rambaud C: Bridging veins and autopsy findings in abusive head trauma. Pediatr Radiol. 45(8):1126-31, 2015
                                                                              23. Wittschieber D et al: Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications. AJNR Am J Neuroradiol. 36(3):432-9, 2015
                                                                              24. Adamsbaum C et al: Dating the abusive head trauma episode and perpetrator statements: key points for imaging. Pediatr Radiol. 44 Suppl 4:S578-88, 2014
                                                                              25. Binenbaum G et al: The eye in child abuse: key points on retinal hemorrhages and abusive head trauma. Pediatr Radiol. 44 Suppl 4:S571-7, 2014
                                                                              26. Case ME: Distinguishing accidental from inflicted head trauma at autopsy. Pediatr Radiol. 44 Suppl 4:S632-40, 2014
                                                                              27. Nadarasa J et al: Update on injury mechanisms in abusive head trauma--shaken baby syndrome. Pediatr Radiol. 44 Suppl 4:S565-70, 2014
                                                                              28. Roach JP et al: Head injury pattern in children can help differentiate accidental from non-accidental trauma. Pediatr Surg Int. 30(11):1103-6, 2014
                                                                              29. Vázquez E et al: Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging? Pediatr Radiol. 44 Suppl 4:S589-603, 2014
                                                                              30. Piteau SJ et al: Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics. 130(2):315-23, 2012