Shaken Baby Syndrome: Magnetic Resonance Imaging Features in Abusive Head Trauma

Area of Science:

• Pediatric Neuroradiology
• Child Abuse Forensics
• Neuroimaging in Pediatrics

Background:

• Abusive head trauma (AHT) is the primary cause of fatal head injuries in children under two years old.
• The immature brain's unique characteristics increase susceptibility to severe injury from violent shaking.
• Diagnosing AHT is complex, requiring a multidisciplinary approach beyond external physical signs.

Purpose of the Study:

• To review the primary Magnetic Resonance Imaging (MRI) findings associated with AHT in infants' central nervous systems.
• To focus on both hemorrhagic and non-hemorrhagic injuries resulting from the biomechanical forces of shaking.
• To provide guidance on optimal MRI protocols for identifying AHT in clinical practice.

Main Methods:

• Review of neuroimaging literature focusing on Magnetic Resonance Imaging (MRI) findings in abusive head trauma.
• Analysis of typical and subtle signs of AHT detectable via MRI, including subdural hematomas and parenchymal lesions.
• Discussion of MRI's role as a radiation-free diagnostic tool in the absence of external trauma indicators.

Main Results:

• MRI is crucial for detecting characteristic AHT findings like subdural hematomas and hypoxic-ischemic damage.
• Subtle signs such as parenchymal lacerations, cranio-cervical junction injuries, and spinal injuries are identifiable with MRI.
• MRI facilitates the identification of both direct and indirect consequences of violent shaking mechanisms.

Conclusions:

• Magnetic Resonance Imaging (MRI) is the preferred modality for diagnosing abusive head trauma (AHT) in infants due to its ability to detect subtle and overt injuries.
• A comprehensive understanding of MRI findings is essential for neuroradiologists to accurately diagnose AHT.
• Standardized MRI protocols can enhance the detection and characterization of AHT, aiding in medical and forensic evaluations.