Is external hydrocephalus a possible differential diagnosis when child abuse is suspected?

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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
06:18

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

Published on: March 26, 2019

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Joseph Scheller1, Knut Wester2

  • 1Neurologist in Private Practice, 600 Reisterstown Rd #301, Baltimore, MD, 21208, USA.

Acta Neurochirurgica
|March 12, 2021
PubMed

Insights

Diagnosing abusive head trauma (AHT) is challenging due to unclear criteria. Benign external hydrocephalus (BEH) in infants can be misdiagnosed as AHT, highlighting the need for expert evaluation.

Area of Science:

  • Pediatrics
  • Neurology
  • Forensic Medicine

Background:

  • Diagnostic criteria for abusive head trauma (AHT), also known as shaken baby syndrome, are not well-defined.
  • This ambiguity can lead to misdiagnoses based on insufficient evidence.

Purpose of the Study:

  • To investigate the potential misdiagnosis of benign external hydrocephalus (BEH) as abusive head trauma (AHT).
  • To propose measures to prevent diagnostic errors in infant head trauma cases.

Main Methods:

  • A study collected data on 28 infants suspected of violent shaking, with caregivers under investigation.
  • Clinical and radiological findings, including head circumference, symptoms, and neuroimaging, were analyzed.

Main Results:

  • Eighty-one percent of symptomatic infants had head circumference at or above the 90th percentile.
  • Macrocephaly and seizures were common symptoms; 65% had bilateral retinal hemorrhages.
  • All infants showed neuroimaging findings consistent with chronic subdural hematomas/hygromas and benign external hydrocephalus (BEH).

Conclusions:

  • Benign external hydrocephalus (BEH) with subdural hematomas/hygromas can be misdiagnosed as abusive head trauma (AHT).
  • Medical experts must be trained in recognizing BEH features.
  • Inclusion of neuro-pediatric clinicians and access to head circumference history are crucial for accurate diagnosis.
Abstract

Keywords:
AHTAbusive head injuryBenign external hydrocephalusChild abuseSBSShaken baby syndromeSubdural haematomasubdural hygroma

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