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Imaging of non-accidental brain trauma Volume 16, issue 3, Juillet-Août-Septembre 2013

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Authors
Université Paris Sud, Faculté de Médecine, France, AP-HP, CHU Bicêtre, service d’Imagerie Pédiatrique, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France, AP-HP, CHU Hôtel-Dieu, Unité Médico-Judiciaire, 1 place du Parvis Notre-Dame 75004 Paris, France

Non-accidental brain trauma, also referred to as “shaken baby syndrome”, represents the main cause of morbidity and mortality in the context of child abuse and particularly affects young infants less than eight months old. The shaking that leads to brain injury is always violent and often repeated. Intracranial lesions may be isolated without skeletal trauma or bruising. Urgent hospitalisation is required as soon as a diagnosis is suspected. Brain CT, which is easy to perform in an emergency, is the key to diagnosis and discloses subdural haematomas at characteristic sites, which are most often diffuse and localised to specific zones : the vertex, interhemispheric space, and tentorium. There is no clear history of trauma and the reported events are changing over time. Based on 2D and 3D analysis of the skull, it is possible to investigate signs of recent impact, such as a fracture and/or a soft tissue swelling of the scalp. Intraparenchymal injuries (contusions, tearing, and particularly anoxic ischaemic injuries) are analysed more effectively by MRI, and prognosis depends on the extent of the injury. Ophthalmological examination and skeletal radiographs are systematically performed in order to investigate retinal haemorrhaging and fractures which may be very subtle. Bruising is a major diagnostic sign, but not always present. It is not possible to accurately date skeletal and/or brain injuries based on imaging and the only useful indication is the fact that “age-different lesions are present”. This reveals repeated non-accidental trauma and therefore a high risk of recurrence.