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What neuroradiological investigations are indicated to identify abusive central neurological system injury in children?

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Abusive head trauma (AHT) is associated with a high morbidity and mortality in children 1-3.  AHT includes a variety of features such as extra-axial haemorrhages with or without cerebral oedema, hypoxic ischaemic injury or cerebral contusion 4.  The identification of these injuries influences both clinical management and subsequent child protection procedures.

 

Neuroimaging is essential to identify these injuries; however, concerns have been expressed about the radiation dosage associated with computerised tomography (CT) scanning and the need for sedation/general anesthesia (GA) for magnetic resonance imaging (MRI) in young children 5.  This review aims to identify the optimal investigation strategy when central neurological system (CNS) injury is suspected.

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References

  1. Duhaime A-C, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. Journal of Neurosurgery. 1987;66:409-415 [Pubmed]
  2. Holloway M, Bye AM, Moran K. Non-accidental head injury in children. Medical Journal of Australia. 1994;160(12):786-789 [Pubmed]
  3. King WJ, MacKay M, Sirnick A, Canadian Shaken Baby Study Group. Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases. Canadian Medical Association Journal. 2003;168(2):155-159 [Pubmed]
  4. Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, Sibert JR, Kemp AM. Subdural haemorrhages in infants: population based study. British Medical Journal. 1998;317(7172):1558-1561 [Pubmed]
  5. Brody AS, Frush DP, Huda W, Brent RL. Radiation Risk to Children From Computed Tomography. Pediatrics. 2007;120(3):677-682 [Pubmed]

 

Section navigation

Is there any value in performing magnetic resonance imaging in children with abnormal computerised tomography scans?

– Results
     – Overall results
     – Age
– Analysis of included studies
– Additional findings

What is the value of magnetic resonance imaging in children with normal initial computerised tomography scans?

– Results
     – Overall results
     – Age

– Study limitations

– Analysis of included studies

Is there any value in performing diffusion weighted imaging in addition to magnetic resonance imaging?

– Results
     – Overall results
     – Age
– Analysis of included studies

What is the value of high resolution ultrasound scans?

– Results
     – Overall results
     – Age
– Analysis of included studies

Implications for practice

Research implications

Limitations of review findings

Other useful references

 

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