Recognizing Signs of Abusive Head Trauma

Abusive head trauma (AHT) remains the leading cause of fatal traumatic brain injury in infants and young children. Diagnosis is frequently delayed or missed due to nonspecific clinical presentation and unreliable histories, making neuroimaging a critical component of the diagnostic process.

This review synthesises computed tomography (CT) and magnetic resonance imaging findings (MRI) associated with abusive mechanisms and highlights patterns that may support clinical suspicion, multidisciplinary decision making and child protection interventions.

A narrative review of characteristic imaging features in AHT was conducted, focusing on the radiologic appearance of retinal haemorrhages, subdural hematomas, subarachnoid and epidural haemorrhages, bridging vein thrombosis, spinal subdural haemorrhages, hypoxic-ischemic damage, parenchymal lesions and skull injuries.

Subdural hematoma was the most frequently reported imaging finding, often bilateral or asymmetric, typically involving the high convexities, the interhemispheric fissure and the posterior fossa. Additional findings commonly associated with AHT included retinal haemorrhages, bridging vein thrombosis, spinal subdural haemorrhage, HII injury, hemispheric hypodensity, traumatic axonal injury and complex skull fractures. MRI demonstrated superior sensitivity compared with CT for detecting small haemorrhages, early parenchymal injury and axonal damage.

Recognition of characteristic neuroimaging patterns plays a central role in the evaluation of suspected AHT. Early identification by radiologists and paediatric clinicians is critical not only for guiding acute management but also for activating multidisciplinary child protection responses and preventing recurrent injury, long-term neurological impairment and fatal outcomes.