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Abusive head trauma: neuroimaging mimics and diagnostic complexities
Jai Sidpra1, Sahil Chhabda2, Adam J Oates3
1University College London Medical School, London, UK.
Insights
Abusive head trauma (AHT) causes many childhood deaths. Neuroimaging is key for diagnosis, but mimics can lead to misdiagnosis, necessitating a clear diagnostic framework for abusive head trauma.
Area of Science:
- Pediatric neurosurgery
- Child abuse diagnostics
- Forensic neuropathology
Background:
- Abusive head trauma (AHT) is a leading cause of death in children under puberty.
- Neuroimaging is crucial for diagnosing AHT due to varied presentations and unclear injury mechanisms.
- Numerous conditions can mimic AHT's clinical and imaging findings, complicating diagnosis.
Purpose of the Study:
- To provide a framework for diagnosing abusive head trauma (AHT) using neuroimaging.
- To review the literature and present illustrative cases of AHT.
Main Methods:
- Exhaustive literature review on AHT diagnosis and neuroimaging.
- Analysis of illustrative clinical cases from institutional experience.
Main Results:
- AHT diagnosis is challenging due to non-specific presentations and lack of pathognomonic imaging patterns.
- Misdiagnosis of AHT has severe repercussions for affected children.
- A structured approach is needed to differentiate AHT from other conditions.
Conclusions:
- A comprehensive framework is essential for accurate neuroimaging interpretation in suspected abusive head trauma (AHT).
- Distinguishing AHT from mimics requires careful consideration of clinical and imaging data.
- Improved diagnostic criteria and frameworks can mitigate misdiagnosis and its consequences.
Abstract:
Traumatic brain injury is responsible for approximately half of all childhood deaths from infancy to puberty, the majority of which are attributable to abusive head trauma (AHT). Due to the broad way patients present and the lack of a clear mechanism of injury in some cases, neuroimaging plays an integral role in the diagnostic pathway of these children. However, this nonspecific nature also presages the existence of numerous conditions that mimic both the clinical and neuroimaging findings seen in AHT. This propensity for misdiagnosis is compounded by the lack of pathognomonic patterns and clear diagnostic criteria. The repercussions of this are severe and have a profound stigmatic effect. The authors present an exhaustive review of the literature complemented by illustrative cases from their institutions with the aim of providing a framework with which to approach the neuroimaging and diagnosis of AHT.
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