Cranial computed tomography in the abused child with head injury

Cranial computed tomographic (CT) findings are described in 37 children with head injuries resulting from physical abuse. CT findings included subarachnoid hemorrhage (27 patients), cerebral edema (24), cerebral hemorrhage (11), and subdural hematoma (nine). Intravenous contrast material was administered in 10 children in whom there were neurologic symptoms or signs but no history or physical signs of trauma or abuse. In five of these children, increased vascularity was seen in areas that later showed infarction. Eight children were studied by both CT and sonography. Sonography detected 50% fewer abnormalities than did CT. It was found that children with skull fracture had the same range of injuries as children without fracture, and they had a higher incidence of subarachnoid hemorrhage. In acutely traumatized children, cranial CT should be the method of choice to provide the most accurate diagnosis and documentation of injury. Skull radiographs should also be obtained because they sometimes show fractures not recognized by CT.