Abusive head trauma in infants and children

Abstract

Abusive head trauma (AHT) in infants and young children are broadly defined as those sustaining perpetrator-inflicted injury of the skull and intracranial contents. Shaken-baby syndrome is a subtype of AHT. The clinical findings might include neurologic signs and symptoms such as irritability, seizures, apnea, vomiting, and poor feeding. The characteristic imaging features of AHT include subdural hematoma, brain parenchymal injury, and retinal hemorrhages. Moreover, young infants are at an increased risk of upper cervical spinal injury such as soft-tissue or ligamentous ones. Therefore, head non-contrast head computed tomography (CT) and magnetic resonance imaging (MRI) including cervical the spine are necessary to diagnose AHT. Non-contrast head CT is the first diagnostic imaging modality for pediatric patients with symptoms. Initial head CT should include 3D reconstruction for the accurate representation of skull fractures. Thereafter, additional complementary MRI is more sensitive for intracranial hemorrhages and parenchymal injuries.

The focus of this article is to review the diagnostic findings of AHT and the optimal diagnostic imaging strategy for it.