Available online 8 May 2024, 101140

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This focused review on abusive head trauma describes the injuries to the head, brain and/or spine of an infant or young child from inflicted trauma and their neuroimaging correlates. Accurate recognition and diagnosis of abusive head trauma is paramount to prevent repeated injury, provide timely treatment, and ensure that accidental or underlying medical contributors have been considered. In this article, we aim to discuss the various findings on neuroimaging that have been associated with AHT, compared to those that are more consistent with accidental injuries or with underlying medical causes that may also be on the differential.

Section snippetsINTRODUCTION

A diagnosis of abusive head trauma (AHT) reflects any inflicted injury to the head, brain, and/or spine of an infant or young child, whether by inertial injury, contact injury, or some combination of the two [1]. AHT is most common in infants in the first year of life and has an estimated incidence of 20-30 cases per 100,000 infants under one year of age [2]. With a mortality rate of nearly 25%, AHT is the leading cause of fatal head injury in children less than 2 years and is the most lethal

Scalp

Injury to the head can result in accumulation of blood within the different layers that comprise the scalp. Blood that has collected beneath the periosteum is referred to as a cephalohematoma. Cephalohematomas may present in neonates from forces applied to the scalp during delivery or outside of the neonatal period as a result of blunt trauma to the scalp. Blood that accumulates in the loose areolar tissue beneath the galea aponeurotica is termed a subgaleal hematoma. Subgaleal hematomas result

DIFFERENTIAL DIAGNOSIS

The evaluation and diagnosis of AHT has significant medical and legal implications with little margin for error. Just as failing to identify abuse can have devastating consequences, so can misattributing a child's injuries to abuse. When making a diagnosis of AHT, other possible diagnoses must be ruled out as well including birth trauma, accidental injuries, structural differences such as benign enlargement of the subarachnoid space (BESS), genetic conditions such as glutaric aciduria and

CONCLUSION

Arriving at a diagnosis of AHT requires a careful examination of the provided and obtained history, physical findings, ophthalmologic exam, and appropriate laboratory tests and imaging. While AHT can and should not be diagnosed on neuroimaging findings in isolation, neuroimaging is an integral part of the evaluation.

CRediT authorship contribution statement

Katherine W. Canty: Writing – review & editing, Writing – original draft, Data curation, Conceptualization. Abigail Keogh: Writing – review & editing, Writing – original draft, Data curation, Conceptualization. Joanne Rispoli: Writing – review & editing, Writing – original draft, Data curation.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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