The findings support performing complete spine imaging for children undergoing brain magnetic resonance imaging (MRI) for moderate or severe traumatic brain injury and suggest a pathway for distinguishing between abusive and accidental injury. The study is published online in the journal Radiology.
According to the researchers, abusive head trauma is the leading cause of significant traumatic brain injury in infants, with a 20 to 38 percent mortality rate and significant neurological and developmental impairment in 30 to 78 percent of survivors.
The radiologic features of abusive head trauma include bleeding within the skull and brain injury. Spinal injuries like spinal subdural hemorrhage -- bleeding in the space between the spinal cord and its tough outer membrane -- are another feature of trauma that may be overlooked clinically in non-fatal cases because of coexistent brain injury and traumatic coma.
"Imaging the whole spine is important in cases of abuse for two reasons," said study author Arabinda Kumar Choudhary, M.D., MRCP, FRCR, pediatric radiologist at Penn State Milton S. Hershey Medical Center and Penn State College of Medicine in Hershey, Pa. "Most of the spinal injuries in abusive head trauma are clinically silent because of extensive injuries elsewhere and lack of a clinical history suggestive of spinal injury. It is important to rule out any significant injury to the spine and spinal cord. Also, spine imaging allows complications of subdural hemorrhage collecting in the spinal canal to be diagnosed earlier."
To study the incidence of spinal subdural hemorrhage, Dr. Choudhary and colleagues looked at clinical data and imaging records for 252 children aged two years old or younger who underwent treatment for abusive head trauma at the medical center. Imaging results included computed tomography (CT) and MRI of the brain, spine, chest, abdomen and pelvis. They compared the imaging results to those from a group of 70 similarly aged children who were treated for accidental trauma.
Spinal canal subdural hemorrhage was evident in more than 60 percent of the children with abusive head trauma who underwent thoracolumbar imaging, or imaging of the thorax and the lumbar regions of the spine. In contrast, spinal canal subdural hemorrhage was rare in accidental trauma. Only one of the 70 children in the accidental trauma group had spinal subdural hemorrhage.
Dr. Choudhary indicated that more research is needed to improve understanding of the relationship between abusive trauma and spinal bleeding and provide another tool for criminal investigators.
"The diagnosis of abusive head trauma is complex," Dr. Choudhary said. "In most of these cases, the history does not fit with the clinical findings. The pathophysiology and diagnosis of abusive head trauma are still being hotly debated, particularly in the courts."
Dr. Choudhary added that it is crucial for radiologists to have all the facts at their disposal to be able to come to a confident diagnosis in possible cases of abusive head trauma. "The more we understand the diagnosis and the more research we have in this area, the better we will be at serving our most vulnerable patients," he said.
"Spinal Subdural Hemorrhage in Abusive Head Trauma: A Retrospective Study." Collaborating with Dr. Choudhary were Ray K. Bradford, M.D., Mark S. Dias, M.D., Gregory J. Moore, M.D., Ph.D., and Danielle K. B. Boal, M.D.
Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.rsna.org/)
RSNA is an association of more than 48,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (http://www.RSNA.org)
For patient-friendly information on MRI and CT, visit http://www.RadiologyInfo.org.
Linda Brooks | EurekAlert!
Ayahuasca compound changes brainwaves to vivid 'waking-dream' state
19.11.2019 | Imperial College London
A step closer to cancer precision medicine
15.11.2019 | University of Helsinki
Nanooptical traps are a promising building block for quantum technologies. Austrian and German scientists have now removed an important obstacle to their practical use. They were able to show that a special form of mechanical vibration heats trapped particles in a very short time and knocks them out of the trap.
By controlling individual atoms, quantum properties can be investigated and made usable for technological applications. For about ten years, physicists have...
An international team of scientists, including three researchers from New Jersey Institute of Technology (NJIT), has shed new light on one of the central mysteries of solar physics: how energy from the Sun is transferred to the star's upper atmosphere, heating it to 1 million degrees Fahrenheit and higher in some regions, temperatures that are vastly hotter than the Sun's surface.
With new images from NJIT's Big Bear Solar Observatory (BBSO), the researchers have revealed in groundbreaking, granular detail what appears to be a likely...
The Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM in Dresden has succeeded in using Selective Electron Beam Melting (SEBM) to...
Carbon nanotubes (CNTs) are valuable for a wide variety of applications. Made of graphene sheets rolled into tubes 10,000 times smaller than a human hair, CNTs have an exceptional strength-to-mass ratio and excellent thermal and electrical properties. These features make them ideal for a range of applications, including supercapacitors, interconnects, adhesives, particle trapping and structural color.
New research reveals even more potential for CNTs: as a coating, they can both repel and hold water in place, a useful property for applications like printing,...
If you've ever tried to put several really strong, small cube magnets right next to each other on a magnetic board, you'll know that you just can't do it. What happens is that the magnets always arrange themselves in a column sticking out vertically from the magnetic board. Moreover, it's almost impossible to join several rows of these magnets together to form a flat surface. That's because magnets are dipolar. Equal poles repel each other, with the north pole of one magnet always attaching itself to the south pole of another and vice versa. This explains why they form a column with all the magnets aligned the same way.
Now, scientists at ETH Zurich have managed to create magnetic building blocks in the shape of cubes that - for the first time ever - can be joined together to...
15.11.2019 | Event News
15.11.2019 | Event News
05.11.2019 | Event News
19.11.2019 | Life Sciences
19.11.2019 | Physics and Astronomy
19.11.2019 | Health and Medicine