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Child Abuse, Brain

KEY FACTS Terminology Nonaccidental trauma, abusive head trauma (AHT) Traumatic injury inflicted on infants & children by adults Imaging Direct impact injury: Direct blow to cranium or impact of skull on object Calvarial (often complex) & skull base fractures Focal brain injury deep to impact Shaking injury: Result of violent “to & fro” motion of head Subdural hematomas (SDH) in 90-98% Generalized parenchymal injuries (cytotoxic edema,…

Chiari 1

KEY FACTS Imaging Pointed cerebellar tonsils extending ≥ 5 mm below foramen magnum with effacement of CSF spaces ± syringohydromyelia &/or scoliosis Best tool: Head NECT may be performed acutely but MR provides best detail of posterior fossa & cervical spinal cord Top Differential Diagnoses Normal low-lying cerebellar tonsils Chiari 2 malformation Tonsillar herniation from increased intracranial pressure Intracranial hypotension Pathology Most common cause believed to…

Approach to Pediatric Brain

Head/Brain Imaging Modalities Radiographs Skull radiographs have limited value in the pediatric patient. They may occasionally be obtained in the setting of trauma, but it should be recognized that they can be falsely reassuring. Pediatric patients can have significant intracranial injuries (including extraaxial hemorrhages & brain parenchymal contusions) without having skull fractures. Additionally, some fractures (particularly of the skull base) will not be readily seen by…