pediatric neuroimaging in cases of suspected nonaccidental head trauma

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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