Related Experiment Videos
Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury
L Ewing-Cobbs1, M Prasad, L Kramer
1Department of Pediatrics, University of Texas Houston Health Science Center 77030, USA. lewing@ped1.med.uth.tmc.edu
Insights
Inflicted traumatic brain injury (TBI) in children often shows subdural hemorrhages and signs of prior brain abnormality on imaging. Non-inflicted TBI is more commonly associated with intraparenchymal hemorrhage and skull fractures.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Child Abuse
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability in children.
- Distinguishing between inflicted and non-inflicted TBI is crucial for appropriate medical and legal management.
- Neuroimaging plays a vital role in the diagnosis and characterization of TBI in pediatric patients.
Purpose of the Study:
- To compare acute CT/MRI findings in children with inflicted versus non-inflicted traumatic brain injury.
- To identify characteristic neuroimaging patterns associated with inflicted TBI in young children.
- To correlate imaging findings with the mechanism of injury in pediatric TBI.
Main Methods:
- Prospective, longitudinal study of 60 children (0-6 years) hospitalized for moderate to severe TBI.
- Classification of TBI into inflicted (n=31) and non-inflicted (n=29) groups.
- Radiological review of acute CT/MRI scans by a blinded radiologist, assessing for various injury patterns and pre-existing abnormalities.
Main Results:
- Inflicted TBI group showed significantly higher rates of subdural interhemispheric and convexity hemorrhages.
- Signs of pre-existing brain abnormality (cerebral atrophy, subdural hygroma, ex vacuo ventriculomegaly) were more frequent in inflicted TBI.
- Intraparenchymal hemorrhage, shear injury, and skull fractures were more common in non-inflicted TBI.
Conclusions:
- Acute neuroimaging in inflicted TBI often reveals multiple extra-axial hemorrhages.
- Findings suggestive of prior brain abnormality are characteristic of inflicted TBI.
- Distinct imaging patterns can help differentiate between inflicted and non-inflicted TBI in children.
Abstract:
Acute CT/MRI findings were examined in a prospective, longitudinal study of 60 children 0-6 years of age hospitalized for moderate to severe traumatic brain injury (TBI). TBI was categorized as either inflicted (n = 31) or noninflicted (n = 29). Glasgow Coma Scale scores and perinatal history were comparable in both groups. Acute CT/MRI studies were visually inspected by a radiologist blind to group membership. Compared with the noninflicted TBI group, the inflicted TBI group had significantly elevated rates of subdural interhemispheric and convexity hemorrhages as well as signs of pre-existing brain abnormality, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly. Intraparenchymal hemorrhage, shear injury, and skull fractures were more frequent after non-inflicted TBI. Subarachnoid hemorrhage and infarct/edema occurred with comparable frequency in both groups. Characteristic acute neuroimaging findings of inflicted TBI included multiple extraaxial hemorrhages in addition to the mild atrophy, subdural hygromas, and ventriculomegaly that suggest prior brain abnormality.