1/8. Pediatric spine and spinal cord injury after inflicted trauma.Pediatric spine and spinal cord injury are rare sequelae of intentional trauma. They may easily be overlooked, however, and probably represent an underreported phenomenon. Recent autopsy data analyzed in conjunction with prior case series indicate that injury to the upper cervical spine and brainstem may significantly contribute to the major morbidity, mortality, and neuropathology in shaken infants. The findings in the previous case report illustrate several important points regarding spine and spinal cord injury after intentional trauma. First, the very young are susceptible to severe, higher cervical injury of both spine and spinal cord. Second, spine and spinal cord injury were initially overlooked because of masked neurologic findings with the concomitant head injury and multiple other systemic injuries. Finally, the child's outcome with significant cognitive delay because of global brain injury in conjunction with the focal high cervical cord injury may support the hypothesis that hypoxic damage could have occurred secondary to brainstem and high cervical cord injury. At the authors' institution, a detailed history and vigilant physical examination are stressed. When the mechanism of injury reported in the history is incongruous with the physical or initial radiographic findings and intentional trauma is suspected, a full skeletal survey, ophthalmologic evaluation, and social evaluation is undertaken. MRI and CT scanning are individualized according to the clinical assessment.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/8. Cerebral atrophy following shaken impact syndrome and other non-accidental head injury (NAHI).PURPOSE OF THE STUDY: To determine the frequency of cerebral atrophy and microcephaly in a group of children with sequential MRI brain scans after surviving a non-accidental head injury (n = 16). methods: Serial head circumference measurements (OFC) were extracted and plotted on standard growth charts for each child retrospectively to determine the frequency of secondary microcephaly. Cerebral atrophy was diagnosed and quantified by measurement of the ventricular/cortical ratio on coronal images of the sequential scans. RESULTS: Acquired microcephaly was found in 15 children (93.8%) over a median follow-up period of 67.93 weeks. There was a significant reduction in the median Z-score for the OFC at the most recent follow-up when compared with that at presentation (p < 0.001, Wilcoxon Signed Rank Test). Cerebral atrophy was found to be the cause of the microcephaly in eight of the 15 children and was evident as early as 9 days after presentation. CONCLUSION: A large proportion of the cohort (93.8%) develops acquired microcephaly after an inflicted head injury and cerebral atrophy is responsible in half of these cases.- - - - - - - - - - ranking = 0.33333333333333keywords = brain (Clic here for more details about this article) |
3/8. Shaking infant trauma induced by misuse of a baby chair.A 2 month old infant presented with bilateral subdural haemorrhages and bilateral subhyaloid haemorrhage. The parent admitted to forceful bouncing of the child in a baby rocker. Experiments showed that violent rocking in the chair could produce extreme alternating acceleration/deceleration forces in excess of those induced by shaking alone. Such handling could not be interpreted as accidental mismanagement and the abusive nature of the process was graphically shown in video recordings of the experiment. Prosecution resulted in a conviction for cruelty, and a suspended sentence.- - - - - - - - - - ranking = 238.34041817836keywords = haemorrhage (Clic here for more details about this article) |
4/8. Cortical hypoxic-ischemic brain damage in shaken-baby (shaken impact) syndrome: value of diffusion-weighted MRI.Shaken-baby syndrome (SBS) is a type of child abuse caused by violent shaking of an infant, with or without impact, and characterized by subdural hematomas, retinal hemorrhages, and occult bone fractures. Parenchymal brain lesions in SBS may be missed or underestimated on CT scans, but can be detected at an earlier stage with diffusion-weighted MRI (DW-MRI) as areas of restricted diffusion. We demonstrate the value of DW-MRI in a 2-month-old baby boy with suspected SBS. The pattern of diffusion abnormalities indicates that the neuropathology of parenchymal lesions in SBS is due to hypoxic-ischemic brain injuries, and not to diffuse axonal injury.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
5/8. Depressed skull fractures: a pattern of abusive head injury in three older children.OBJECTIVE: To describe a pattern of abusive head injury in a series of children older than 4 years of age. methods: A hospital chart review of abused children with skull fractures from 1999 to 2001 was carried out. The clinical features, social background, and subsequent outcome and management are described. RESULTS: An 11-year-old girl and a pair of brothers of ages 7 and 9 were identified. The girl was attacked with a hammer during sleep by her stepmother, who committed suicide shortly afterwards. After craniotomy and intensive care, the child survived her multiple depressed fractures, intracranial bleeding, and brain contusion. Two brothers from a second family were attacked from behind with a hammer by their biological father, who was subsequently found to have undiagnosed schizophrenia. A depressed occipital fracture, without intracranial injury, was found in each child. The elder brother also had metacarpal fractures. Both children recovered without surgical intervention. CONCLUSION: A pattern of abusive head injury was described in older children with depressed skull fractures from blunt injury. The abusing parents were seriously mentally disturbed, and the abusive acts closely resembled child homicide.- - - - - - - - - - ranking = 0.33333333333333keywords = brain (Clic here for more details about this article) |
6/8. Biochemical markers of brain injury: could they be used as diagnostic adjuncts in cases of inflicted traumatic brain injury?child abuse is the leading cause of serious traumatic brain injury (TBI) in infants and young children (Billmire & Myers, 1985; Bruce & Zimmerman, 1989). The incidence of serious or fatal inflicted traumatic brain injury (iTBI) in children < 1 year of age is approximately 1 in 3,300 ( Keenan et al., 2003); since many cases of iTBI are of mild or moderate severity, the incidence is probably significantly higher. Even at an incidence of 1 in 3,300, iTBI is as common as the incidence of cystic fibrosis (CF), the most common genetic recessive disease in the Caucasian population. Proper diagnosis of iTBI is difficult even for experienced and astute physicians because its presentation can be subtle and important historical data are often lacking. As a result, misdiagnosis is common and can have catastrophic medical consequences for patients and significant financial consequences for society ( Ewing-Cobbs et al., 1998; Jenny, Hymel, Pitzen, Reinert, & Hay, 1999). Unlike CF for which there are several well established screening tests, there are currently no diagnostic adjuncts to help physicians screen for possible iTBI.- - - - - - - - - - ranking = 3.3333333333333keywords = brain (Clic here for more details about this article) |
7/8. Normal computerized tomography of brain in children with shaken baby syndrome.OBJECTIVE: To characterize the clinical presentation and clinical course of shaken baby syndrome (SBS) with normal cranial computerized tomography (CT) on admission and to suggest further diagnostic procedures in such circumstances. methods: Using a worldwide listserv designed to facilitate discussion in the field of child abuse and neglect, we solicited case information for children hospitalized in different medical centers, who were diagnosed with SBS and had a normal CT scan on admission. RESULTS: Nine cases were identified. While all children had an abnormal neurologic examination on admission, eight had a normal CT, and one had "widening of cranial sutures." In four cases, subdural hemorrhage was diagnosed on magnetic resonance imaging (MRI) 3 to 7 days after admission. Five children had bone fractures. The neurological outcome was normal in four of nine cases. Five children had long-term neurologic damage. The diagnosis of SBS was supported by either perpetrator confession, characteristic evolution of brain abnormalities on CT or MRI, inconsistent or absent explanatory history, and/or other social risk factors. CONCLUSION: The diagnosis of SBS can be established even when brain CT is normal on admission. The documentation of retinal hemorrhages is of primary importance in establishing the diagnosis of SBS in these cases.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
8/8. Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse.PURPOSE: To present the occasional observation of retinal haemorrhages in premature babies, as a diagnostic alternative to those observed as part of shaken baby syndrome. methods: We carried out an observational study on 11 infants in whom retinal and/or vitreous haemorrhages had been observed within their first months of life. Ten infants were under surveillance for retinopathy of prematurity (ROP), with gestational ages and birth weights in the ranges of 27--34 weeks and 790--1665 g, respectively. One infant was diagnosed with Zellweger's syndrome and one received substitution therapy for coagulation factor II deficiency. The last child had been delivered at 38 weeks, weighing 2070 g; he died on day 5 from severe brain oedema with incarceration and extensive bilateral fundus bleeding. RESULTS: Four of the 11 infants had some evidence of ROP, and two later received retinal ablation therapy. Contrary to the quick absorption (<1-2 weeks only) usually seen in most newborn term infants, the ocular bleeding in preterms was generally longstanding. A quick increase in intracranial pressure probably played a role in the lethal case with delivery near term, and one infant received lung physiotherapy for pneumonia at the age of 6 months. Some bleeding appeared to be truly postnatal (i.e. it was observed as a new occurrence during the course of surveillance). CONCLUSIONS: In the series under study there was no suspicion of child abuse. In term infants, retinal haemorrhages are extremely rare except when due to shaking, but other diseases should be ruled out, coagulopathies in particular. We suggest that prematurity as such is added to the list of possibly underlying causes when retinal bleedings are evaluated in very small infants and shaken baby mechanisms are suspected.- - - - - - - - - - ranking = 834.52479695759keywords = haemorrhage, brain (Clic here for more details about this article) |