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Published on: August 30, 2020
Neuroradiological aspects of subdural haemorrhages
S Datta1, N Stoodley, S Jayawant
1Dept of Neuroradiology and Child Health, University Hospital of Wales, Cardiff, . shalinidatta@btinternet.com
Insights
Neuroimaging can identify features of non-accidental head injury (NAHI) in infants with subdural haemorrhage (SDH). Specific patterns like interhemispheric or multi-site SDHs strongly suggest NAHI, with MRI proving more sensitive than CT.
Area of Science:
- Pediatric Neuroradiology
- Child Abuse and Neglect
- Neuroimaging Techniques
Background:
- Subdural haemorrhage (SDH) in infants and young children can be a sign of non-accidental head injury (NAHI).
- Accurate neuroimaging is crucial for diagnosing SDH and identifying potential abuse.
Purpose of the Study:
- To review neuroimaging findings in infants and young children hospitalized with subdural haemorrhage (SDH).
- To identify radiological features suggestive of non-accidental head injury (NAHI).
Main Methods:
- Retrospective review of neuroradiological investigations for 74 children under 2 years with diagnosed SDH or subdural effusion.
- Independent review of all relevant images by two blinded pediatric neuroradiologists.
Main Results:
- Specific radiological features, including interhemispheric haemorrhages and multi-site/multi-density SDHs, were highly indicative of NAHI.
- MRI demonstrated higher sensitivity than CT for detecting SDHs with varying signal characteristics, posterior/middle cranial fossa bleeds, and parenchymal changes.
- Suboptimal CT protocols were associated with missed small subdural bleeds.
Conclusions:
- Neuroimaging guidelines for suspected NAHI are recommended, emphasizing the need for experienced radiologist reporting.
- Initial investigation should involve CT, with MRI often necessary for comprehensive evaluation.
- Head CT is recommended as part of skeletal surveys for infants <6 months undergoing child protection investigation and for children <2 years with suspected abuse and neurological signs, retinal haemorrhages, or fractures.
Aims:
To review the neuroimaging of a series of infants and young children admitted to hospital with subdural haemorrhage (SDH).
Methods:
Neuroradiological investigations of 74 children under 2 years of age, from South Wales and southwest England, in whom an SDH or subdural effusion had been diagnosed between 1992 and 2001, were reviewed. Two paediatric neuroradiologists blinded to the original radiological report reviewed all the relevant images.
Results:
Neuroradiological review of images identified radiological features which were highly suggestive of non-accidental head injury (NAHI). Interhemispheric haemorrhages and SDHs in multiple sites or of different densities were almost exclusively seen in NAHI. MRI was more sensitive in identifying SDHs of different signal characteristics, posterior and middle cranial fossa bleeds, and parenchymal changes in the brain. CT scans, if performed with suboptimal protocols, were likely to miss small subdural bleeds.
Conclusions:
Guidelines for neuroimaging in suspected NAHI are recommended. A radiologist with experience in NAHI should report or review these scans. The initial investigation should be CT, but MRI will also be necessary in most cases. Head CT should be an integral part of the skeletal survey in all infants less than 6 months of age referred for child protection investigation, and in children less than 2 years where child abuse is suspected and there are neurological signs, retinal haemorrhages, or fractures.
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