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What neuroradiological features distinguish abusive from non-abusive head trauma?

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.


New high quality studies have enabled us to update the original meta-analysis and in particular they make an important contribution with regard to the significance of bilateral subdural haemorrhages and diffuse axonal injury.


Neuroimaging is undertaken in infants where abusive head trauma (AHT) is suspected. The neuroimaging must be interpreted carefully, in the context of the historical or clinical features, giving due consideration to the differential causes of intracranial injury in infancy e.g. intentional trauma, birth-related injury, bleeding disorders, encephalitis, meningitis, congenital abnormality or metabolic conditions such as glutaric aciduria. This systematic review evaluates the strength of the scientific evidence behind the neuroradiological features that are associated with AHT.


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   – Overall results
   – Age

   – Gender

   – Neuroimaging

   – Influence of ethnicity and socio-economic group

Extra-axial haemorrhages

   – Subdural haemorrhages

   – Subarachnoid haemorrhages

   – Extradural haemorrhages

Distribution of extra-axial haemorrhages

   – Interhemispheric haemorrhages

   – Multiple extra-axial haemorrhages

   – Subdural haemorrhages over the convexities

   – Infra-tentorial/posterior fossa haemorrhages

   – Bilateral haemorrhages

   – Attenuation of extra-axial haemorrhages on initial computerised tomography scan

Intracerebral lesions

   – Cerebral oedema

   – Parenchymal injury

   – Shear injury and diffuse axonal injury

   – Hypoxic ischaemic injury

   – Closed head injury

Implications for practice

Research implications

Limitations of review findings

Other useful references


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