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ID:37946186
大小:2.36 MB
页数:38页
时间:2019-06-03
《pediatric neuroimaging in cases of suspected nonaccidental head trauma》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、PediatricNeuroimaginginCasesofSuspectedNon‐AccidentalHeadTraumaAlexandra“Sasha”RoseCliftonHMSClassof2010BIDMCPCE2008‐2009Note:AllcaseimagesarecourtesyofChildren’sHospitalBostonNon‐AccidentalHeadTrauma(NAHT)•CNSinjuryistheprinciplecauseofdeathfromchildabu
2、se.•Upto64%ofheadinjuriesininfants3‐11mosaresecondarytoabuse.•Cryingisbelievedtobethemainprovocativefactor.•Outcomes:Mortalityrangesfrom15‐38%http://media.photobucket.com/image/shaken%20baby%20syndrome/cazzie53/SBS4444.jpg?o=23Whyareinfantsmorevulnerable
3、?Mechanism:•Generallybelievedtobeduetoacceleration/decelerationforcesespeciallyoftherotationaltype.•Thereissignificantcontroversyregardingwhetherornotimpactisrequiredtocausesignificantdamage.(“Shaken‐ImpactSyndrome”).•Apneaandbrainswellingleadingtohypoxi
4、c‐ischemicencephalopathy.InfantSusceptibility:•Peak@6monthsofage.•Relativelylargeheads•Weakneckmuscles•Relativelylargesubarachnoidspaces•Immaturemyelinationandsmallsizeaxonsleadingtosofterbrains•Thin,softskullsthateasilytransmitforcesfromtheimpulsetodeep
5、erstructuresShakenBabySyndromeSimulator•Infantsaremorepronetoapneahttp://www.thingamababy.com/baby/2007/07/shakenbaby.htmlTheRoleofRadiographicEvidenceNAHTisoftenmisdiagnosedormissedandimagingmaybethefirstindicationofabuse…1.Diagnosis2.DocumentationAsses
6、sment–IdentifytheextentofinjuryElucidateallimagefindingsSuggestadifferentialdiagnosis…buttheimplicationsareextremelyserious!Note:Skeletaltraumaisthemainradiologicalmanifestationofnon‐accidentaltrauma.OurPatient~“Casey”*AbbreviatedHistoryCC:“Casey”isaprev
7、iouslyhealthy4montholdgirlbroughttotheBostonChildren’sHospitalEmergencyRoombyhergrandmotherwithanapparentALTE(acutelifethreateningevent).HPI:Onthedayofadmission“Casey”wastakinghermorningbottlewhenshebegantoactverysleepy,becamelimpandthenturnedblue.Thegra
8、ndmotherreportsthat“Casey”hashadseveralotherepisodeswhereshebecomesslightlylimp,buttheseepisodeshaveresolvedwithinseveralminuteswithoutnoticeablecolorchange.Thepediatricianwasawareoftheepisodesand,atthetime,attributedthemt
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