Craniocerebral trauma in the child abuse syndrome

Craniocerebral trauma, and more specifically intracranial injury, is the most devastating consequence of child abuse. Cranial computed tomography provides a sensitive method for evaluation of the abused child for craniocerebral injury. CT may be particularly useful for demonstrating intracranial lesions that might not be immediately evident from clinical examination. The CT findings may also clarify the nature of the trauma, both cranial and intracranial, with detail not otherwise possible. It is therefore surprising that an expanded role for CT in evaluation of child abuse has not received wider general consideration or acceptance. Discussions of child abuse either fail to note CT in evaluation of the abused child or give the subject only cursory attention. Caffey's initial admonition that the presence of unexplained fractures in the long bones warrants investigation for subdural hematoma has gone largely unheeded. A high index of suspicion for abuse, especially in the young infant, should be sufficient reason to request cranial CT. In some cases of abuse without acute neurologic abnormality chronic sequelae, otherwise unsuspected, may be demonstrated by follow-up CT.