Cerebral Hemodynamics in Pediatric Abusive Head Trauma: 3 Severe Cases with Preserved Motor Cortex, Hyperperfusion, and Recovery of Mild Paralysis

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Abusive head trauma in infants and young children can have a significant impact on neurological outcomes and, in severe cases, may be life-threatening. We report 3 cases of abusive head trauma that presented with acute subdural hematomas on computed tomography scans, accompanied by extensive low-density areas and parenchymal brain swelling. All patients exhibited impaired consciousness due to brain injury and underwent craniotomy for hematoma evacuation as well as extensive decompressive craniectomy. Despite the severity of the initial presentation, hemiparesis was mild and gradually improved over several months. Postoperative magnetic resonance imaging revealed widespread parenchymal injury but preservation of the corticospinal tract, including the precentral gyrus. In the acute phase, diffusion-weighted imaging showed no irreversible infarction in the motor cortex, and arterial spin labeling demonstrated increased perfusion in peri-motor regions of the affected hemisphere. These findings suggest that preserved corticospinal pathways and compensatory hyperperfusion may correlate with favorable motor recovery even in the presence of extensive parenchymal damage. These cases highlight the radiological features and short-term neurological outcomes of abusive head trauma, demonstrating preserved motor function despite extensive parenchymal damage.