Original articleNon-accidental brain trauma in infants: diffusion imaging, contributions to understanding the injury processTraumatismes non accidentels du nourrisson : imagerie de diffusion, contributions dans la compréhension des mécanismes
Introduction
Since the introduction of diffusion-weighted imaging (DWI) in the mid-1990s as a tool in the identification of acute cytotoxic cell edema, the technique's major clinical application has been to evaluate adult stroke [9], [10] and neonatal hypoxic ischemic brain injury [1], [12]. To a lesser extent, DWI has made contributions in the characterization of central nervous system (CNS) metabolic disorders [8], certain pediatric brain tumors [4] and cerebral traumatic lesions [7].
This paper looks at the patterns of DWI abnormalities in non-accidental trauma (NAT) in infants and young children who have been the victims of abuse. This is a subject that has received relatively little attention in the literature [2], [11].
Section snippets
Materials and methods
Thirty-three infants and young children, 22 males and 11 females, ranging from 3 weeks to 4 years of age, were evaluated with MRI and DWI over a 4-year period of time. Twenty-five of 33 (76%) were 6 months or younger.
All of the patients selected for this study had an acute brain injury with a positive DWI (restricted motion of water). The 33 patients had a total of 57 CT and 40 MRI examinations during the acute phase of hospitalization following trauma. In all cases a CT preceded the MRI
Results
Five imaging patterns were found with DWI in the 33 patients with NAT. One type consisted of diffuse supratentorial brain swelling (infarction) involving the cortex and white matter of all cerebral lobes bilaterally. This was present in 13/33 (39%) (Fig. 1). The second pattern showed watershed infarction involving the parasagittal region between the anterior and middle cerebral arteries anteriorly and the posterior middle cerebral arteries posteriorly. In some cases there was also involvement
Discussion
The neuroimaging evaluation of non-accidental brain trauma in infants and young children has evolved dramatically over the last four decades from plain skull films and invasive cerebral arteriography to computed tomography (CT) and MRI. Plain films and CT continue to play an important role in identifying skull fracture as evidence of direct calvarial trauma [3]. CT and conventional MRI with T1, T2, and FLAIR, are the modalities most often utilized for the evaluation of both subdural hematomas
Conclusion
DWI, besides being sensitive to acute brain injury in non-accidental brain trauma, has been found to have patterns of injury that indicate different mechanisms by which the brain is injured.
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Imaging of Abusive Head Trauma in Children
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2022, Bulletin de l'Academie Nationale de MedecinePearls and Pitfalls in Imaging of Abusive Head Trauma
2020, Seminars in Ultrasound, CT and MRICitation Excerpt :Infarcted areas will demonstrate restricted diffusion (ie, hyperintense signal on DWI and hypointense signal on apparent diffusion coefficient). The most common imaging finding is a diffuse ischemic supratentorial involvement and a watershed infarct pattern in the cerebrum.12,19 The posterior circulation territories including the brainstem, cerebellum and the thalami may be spared secondary to autoregulation.
Cerebellar lesions in pediatric abusive head trauma
2019, European Journal of Paediatric NeurologyCitation Excerpt :Cerebellar changes following shaking in AHT have only rarely been described and even less reported. In two reports on patients with AHT, three figures showed additional cerebellar lesions in 3 patients on DWI similar to the ones we found in our patients: Two cases with cerebellar involvement were reported by Zimmerman et al. 2007.14 They described five different imaging patterns on DWI in 33 infants with NAHT.
The neuroimaging mimics of abusive head trauma
2019, European Journal of Paediatric NeurologyCitation Excerpt :Subarachnoid haemorrhage as a solitary finding is non-discriminatory.25 Parenchymal contusions and diffuse axonal injury are uncommon findings in children with AHT.26 This entity is associated with various forms of delivery, both instrumented and non-instrumented.
Pediatric Emergencies: Imaging of Pediatric Head Trauma
2018, Seminars in Ultrasound, CT and MRICitation Excerpt :With severe trauma, hypoxic-ischemic injury (HII) may be seen in association with extra-axial hemorrhage and is more common in the setting of AHT compared to accidental injuries (Figs. 30 and 31). Common imaging patterns of HII include diffuse ischemic injury, watershed distribution injury, and, less commonly, focal injury or venous infarction.26 Often the amount of subdural hemorrhage is small in relation to the extent of HII, but may serve as a potential marker of trauma.