Patterns of Head Injury in Non Accidental Trauma

1
Patterns of Head Injury in Non Accidental Trauma
Lawrence Buadu, MD PhD, Sven Ekholm MD PhD, Ann
Lenane MD, Toshio Moritani MD, Akio Hiwatashi MD,
PL Westesson MD. University of Rochester Medical
Center, Rochester, New York
Fig 1.
Fig 6.
Scalp Swelling
Hypoxic Ischemic Injury
Fig 6. 2 month old female infant presenting with
seizures and apnea. Non-enhanced CT (NECT) shows
the reversal sign with diffuse and extensive
hypodensity of the cerebral cortices and relative
sparing of the basal ganglia and cerebellum.
Fig 1. Scout image from a CT exam in an 8 month
old male with suspected NAHI head injury shows
biparietal soft tissue swelling (fig 1a.).
Coronal T1 gradient echo images (fig 1b) show the
biparietal subgaleal hemato-mas to better
advantage.
Fig 7.
Fig 2.
Fracture
Shear Injury
Fig 7. 14 day old male infant with new onset
focal seizures, fever and swelling on the right
forehead. Axial CT shows a focus of hemorrhage
over the left temporal tip (arrow) (fig 7a).
Axial T1 and T2-weighted images confirm the
presence of hemorrhage at the right temporal tip
(fig 7b c). Diffusion weighted image shows two
punctuate foci of restricted diffusion (arrows)
in the left parietal lobe most consistent with
axonal injury (fig 7d). ADC values (not shown)
were diminished.
Fig 2 8 month old male with suspected NAHI
(same patient as fig 1). Axial nonenhanced CT
exam with bone algorithim shows a linear defect
(arrow) in the right parietal region (fig 2a)
consistent with frac-ture. A second fracture in
the left parietal region (arrow) is less
apparent. 3D recon-structed images (fig 2b)
depict the right parietal fracture clearly
(arrows) however, the left parietal fracture
(arrows) is less apparent due to a smoothing
effect (fig 2c). MIP images (fig 2d) shows the
left parietal fracture to best advantage.
Fig 3.
Fig 8.
Atrophy
Subdural Hematoma
Fig 8. 2 month old female infant presenting
with seizures and apnea (same patient as fig 7.)
Initial midline sagittal T1WI shows relative
preservation of parenchymal volume. Follow-up MR
image 9 days later shows significant loss of
volume and the relatively rapid progression of
severe diffuse brain injury to atrophy.
Fig 3. 5 month old male child with nonreactive
pupils and sus-pected NAHI. Coronal T1 SPGR image
demonstrates a left interhemispheric SDH (fig
3a). A right SDH (arrows) which is less apparent
on the TIWI is seen to better ad-vantage on the
more sensitive gradient echo image (fig 3b).
Fig 4.
Fig 9.
Infarction
Subarachnoid Hemorrhage
Fig 4. 9 month old male presenting with
suspected nonaccidental trauma and retinal
hemorrhages. Sagittal T1-weighted image shows a
right SDH (fig 4a). Axial fluid attenuated
inversion recovery image demonstrates SAH
(arrows) in the right parietal region (fig 4b).
Fig 9. 2 year old female who initially presented
with seizure. Axial T1-weighted image (fig 9a)
shows a small right SDH (arrows). Axial flair
image (fig 9b) shows a small amount of SAH
(arrows). DWI was normal. Child injury survey(not
shown) at the time was also normal. A month later
the child returned with a history of a fall which
resulted in a right tibia/fibula fracture. A
repeat MR exam shows multiple areas of subacute
infarction on T1, flair and DWI (fig 9d, e f).
Fig 5.
Intraparenchymal Hematoma
Fig 5. 5 month old female who presented with
altered mental status and retinal hemo-rhages on
physical examin-ation. Sagittal T1-weighted (fig
5a.) and gradient echo (fig 5b) images
demonstrate an intra-parenchymal hematoma.