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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), shaken-baby syndrome (SBS)
              • Nonaccidental head injury (NAHI)
            • 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

                    • 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. 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
                                      2. Mankad K et al: The neuroimaging mimics of abusive head trauma. Eur J Paediatr Neurol. 23(1):19-30, 2019
                                      3. Silverman LB et al: Cytotoxic edema in pediatric abusive head trauma: adopting a common nomenclature. J Neuroimaging. 29(2):272-3, 2019
                                      4. Thamburaj K et al: Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma. Pediatr Radiol. 49(2):210-6, 2019
                                      5. Wittschieber D et al: Understanding subdural collections in pediatric abusive head trauma. AJNR Am J Neuroradiol. 40(3):388-95, 2019
                                      6. Choudhary AK et al: Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol. 48(8):1048-65, 2018
                                      7. Gencturk M et al: Various cranial and orbital imaging findings in pediatric abusive and non-abusive head trauma, and relation to outcomes. Clin Neuroradiol. ePub, 2018
                                      8. 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):1915-1923, 2018
                                      9. Teixeira SR et al: Ocular and intracranial MR imaging findings in abusive head trauma. Top Magn Reson Imaging. 27(6):503-514, 2018
                                      10. Kralik SF et al: Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients. Pediatr Radiol. 47(8):942-951, 2017
                                      11. 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
                                      12. Wright JN: CNS Injuries in abusive head trauma. AJR Am J Roentgenol. 28:1-11, 2017
                                      13. 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
                                      14. Girard N et al: Neuroimaging differential diagnoses to abusive head trauma. Pediatr Radiol. 46(5):603-14, 2016
                                      15. Palifka LA et al: Parenchymal brain laceration as a predictor of abusive head trauma. AJNR Am J Neuroradiol. 37(1):163-8, 2016
                                      16. Choudhary AK et al: Venous injury in abusive head trauma. Pediatr Radiol. 45(12):1803-13, 2015
                                      17. Cowley LE et al: Validation of a prediction tool for abusive head trauma. Pediatrics. 136(2):290-8, 2015
                                      18. 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
                                      19. Rambaud C: Bridging veins and autopsy findings in abusive head trauma. Pediatr Radiol. 45(8):1126-31, 2015
                                      20. Wittschieber D et al: Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications. AJNR Am J Neuroradiol. 36(3):432-9, 2015
                                      21. 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
                                      22. 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
                                      23. Case ME: Distinguishing accidental from inflicted head trauma at autopsy. Pediatr Radiol. 44 Suppl 4:S632-40, 2014
                                      24. Nadarasa J et al: Update on injury mechanisms in abusive head trauma--shaken baby syndrome. Pediatr Radiol. 44 Suppl 4:S565-70, 2014
                                      25. 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
                                      26. 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
                                      27. Piteau SJ et al: Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics. 130(2):315-23, 2012
                                      28. Barnes PD: Imaging of nonaccidental injury and the mimics: issues and controversies in the era of evidence-based medicine. Radiol Clin North Am. 49(1):205-29, 2011
                                      29. Ashwal S et al: Advanced neuroimaging in children with nonaccidental trauma. Dev Neurosci. 32(5-6):343-60, 2010
                                      30. Hedlund GL et al: Neuroimaging of abusive head trauma. Forensic Sci Med Pathol. 5(4):280-90, 2009
                                      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), shaken-baby syndrome (SBS)
                                                  • Nonaccidental head injury (NAHI)
                                                • 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

                                                        • 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. 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
                                                                          2. Mankad K et al: The neuroimaging mimics of abusive head trauma. Eur J Paediatr Neurol. 23(1):19-30, 2019
                                                                          3. Silverman LB et al: Cytotoxic edema in pediatric abusive head trauma: adopting a common nomenclature. J Neuroimaging. 29(2):272-3, 2019
                                                                          4. Thamburaj K et al: Susceptibility-weighted imaging of retinal hemorrhages in abusive head trauma. Pediatr Radiol. 49(2):210-6, 2019
                                                                          5. Wittschieber D et al: Understanding subdural collections in pediatric abusive head trauma. AJNR Am J Neuroradiol. 40(3):388-95, 2019
                                                                          6. Choudhary AK et al: Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol. 48(8):1048-65, 2018
                                                                          7. Gencturk M et al: Various cranial and orbital imaging findings in pediatric abusive and non-abusive head trauma, and relation to outcomes. Clin Neuroradiol. ePub, 2018
                                                                          8. 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):1915-1923, 2018
                                                                          9. Teixeira SR et al: Ocular and intracranial MR imaging findings in abusive head trauma. Top Magn Reson Imaging. 27(6):503-514, 2018
                                                                          10. Kralik SF et al: Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients. Pediatr Radiol. 47(8):942-951, 2017
                                                                          11. 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
                                                                          12. Wright JN: CNS Injuries in abusive head trauma. AJR Am J Roentgenol. 28:1-11, 2017
                                                                          13. 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
                                                                          14. Girard N et al: Neuroimaging differential diagnoses to abusive head trauma. Pediatr Radiol. 46(5):603-14, 2016
                                                                          15. Palifka LA et al: Parenchymal brain laceration as a predictor of abusive head trauma. AJNR Am J Neuroradiol. 37(1):163-8, 2016
                                                                          16. Choudhary AK et al: Venous injury in abusive head trauma. Pediatr Radiol. 45(12):1803-13, 2015
                                                                          17. Cowley LE et al: Validation of a prediction tool for abusive head trauma. Pediatrics. 136(2):290-8, 2015
                                                                          18. 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
                                                                          19. Rambaud C: Bridging veins and autopsy findings in abusive head trauma. Pediatr Radiol. 45(8):1126-31, 2015
                                                                          20. Wittschieber D et al: Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications. AJNR Am J Neuroradiol. 36(3):432-9, 2015
                                                                          21. 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
                                                                          22. 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
                                                                          23. Case ME: Distinguishing accidental from inflicted head trauma at autopsy. Pediatr Radiol. 44 Suppl 4:S632-40, 2014
                                                                          24. Nadarasa J et al: Update on injury mechanisms in abusive head trauma--shaken baby syndrome. Pediatr Radiol. 44 Suppl 4:S565-70, 2014
                                                                          25. 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
                                                                          26. 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
                                                                          27. Piteau SJ et al: Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics. 130(2):315-23, 2012
                                                                          28. Barnes PD: Imaging of nonaccidental injury and the mimics: issues and controversies in the era of evidence-based medicine. Radiol Clin North Am. 49(1):205-29, 2011
                                                                          29. Ashwal S et al: Advanced neuroimaging in children with nonaccidental trauma. Dev Neurosci. 32(5-6):343-60, 2010
                                                                          30. Hedlund GL et al: Neuroimaging of abusive head trauma. Forensic Sci Med Pathol. 5(4):280-90, 2009