Abusive Head Trauma

KEY FACTS

Terminology

• Intentionally inflicted injury; abusive head trauma, inflicted head injury, nonaccidental head injury

Imaging

• Plays key role in early diagnosis

  • Disparate brain injuries relative to proffered history

• Skeletal survey, NECT as initial primary imaging tools

  • Detection/characterization of intracranial hemorrhage

  • Detection/characterization of fractures

• MR

  • Delayed (24-72 hours) for detection of parenchymal injuries, demonstration of unexplained, different-aged subdural hemorrhages (SDHs)

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      Use T1WI, T2WI, T2*/SWI (best sequence varies with SDH age)

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      DWI key for identification of parenchymal insult

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      Use T1W1 C+ to detect subdural membranes of chronic SDH

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      Sagittal/coronal best for small peritentorial SDHs

Pathology

• Direct impact injury

  • Skull fractures

  • Underlying brain injury

• Violent “to and fro” shaking

  • Diffusely distributed subdural hematomas

  • Cortical contusions, axonal injury, parenchymal lacerations

• Ischemic injury

  • Global hypoxic brain injury

  • Territorial infarcts

  • Excitotoxic edema

Clinical Issues

• 17-25:100,000 annually

  • 1,200 deaths per year in USA

• Most common cause of traumatic death in infants

• 1/3 of perpetrators under influence of alcohol or drugs

• Mortality: 15-60%

• Signs of trauma (e.g., Battle sign, raccoon eyes) may be present but often are not

TERMINOLOGY

IMAGING