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Abusive Head Traumas in 4 Infants
Won Jae Lee1, Yong Cheol Lim1, Soo Han Yoon1
1Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
Insights
Pediatric abusive head trauma (AHT) is a severe form of child abuse. This study highlights a concerning increase in infant AHT cases in Korea, emphasizing the need for heightened clinical awareness among neurosurgeons.
Area of Science:
- Pediatrics
- Neurology
- Forensic Medicine
Background:
- Pediatric abusive head trauma (AHT) is a significant cause of severe brain injury in children.
- Infant AHT cases are reported infrequently in Korea, making early diagnosis challenging.
- This study examines recent infant AHT cases within a single institution.
Observation:
- Four infant cases of AHT were diagnosed over two years, with a mean age of 7.2 months.
- Patients presented with non-specific symptoms like seizures and respiratory arrest, often without a reported history of head trauma.
- Ophthalmologic findings (retinal hemorrhages) and skeletal injuries (skull and extremity fractures) were noted in some cases.
Findings:
- All infants required emergent neurosurgical intervention for acute subdural hemorrhages.
- Outcomes were poor, with two deaths and two patients left in a vegetative state.
- The study observed a recent increase in AHT frequency in Korea.
Implications:
- Neurosurgeons and pediatricians must maintain a high index of suspicion for AHT in infants, even with minimal or no history of head trauma.
- Timely diagnosis and intervention are critical, though outcomes remain grim.
- Increased awareness and reporting are crucial for addressing the rising incidence of infant AHT in Korea.
Abstract:
Pediatric abusive head trauma (AHT) is a serious, repeated child abuse that causes grave brain damage. In Korea, AHT cases have been reported rarely, especially infants. We present 4 cases of AHT in infants diagnosed in our institution during last 2 years. We collected the demographic data, ophthalmologic examination, imaging study, and outcomes. The mean age was 7.2 months, and 2 infants were girls and the others were boys. All four were admitted with no history of head trauma, and among them 2 patients presented with an episode of seizure and respiratory arrest with no history of head trauma. The initial mental status was semi-coma in 3 cases, and stupor in 1 case. There were multiple retinal hemorrhages in both eyes in 2 cases; one had multiple old fractures on the extremities and another child showed multiple skull fractures. All patients underwent emergent surgery for acute bilateral subdural hemorrhages; 3 had craniotomy and another had burr-hole drainage. Two children expired and the other 2 are in vegetative status. The AHT has recently become more frequent in Korea so that neurosurgeons must alert AHT even in infants with head trauma.
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