You are here » CORE INFO » Reviews » Neurological Injuries » What neuroradiological features distinguish abusive from non-abusive head trauma? » Further intracranial lesions

Further intracranial lesions

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.


 19 studies described further intracranial lesions 1-19


Cerebral oedema

  • A meta-analysis of seven studies 2,5,6,12,13,16,19 showed that cerebral oedema was significantly associated with abusive head trauma (AHT) (odds ratio (OR) 2.24, 95% confidence interval 1.18-4.26, I2=62%; p=0.01) 


Intra-Parenchymal injury

Nine studies 1,3,5,7,8,10-12,19 described intra-parenchymal injury; however, there was no significant association with AHT (OR 1.25, 95% confidence interval 0.58-2.69, I2=73%; p=0.56)

One study noted significantly more parenchymal haemorrhage amongst AHT vs nAHT p<0.001 3



Shear injury and diffuse axonal injury

  • Six studies 2,5,9-11,18 addressed  shear injury or diffuse axonal injury, enabling a meta-analysis to be performed for the first time (OR 3.19, 95% confidence interval 1.14-8.93, I2=10%;p=0.03)


Hypoxic ischaemic injury

  • Six studies addressed hypoxic ischemic injury (HII) 10-12,14,16,18
  • Ichord et al 11 was the only study based purely on magnetic resonance imaging (MRI) imaging which has the greatest sensitivity for HII.  The study stated that HII was predominantly bilateral and generalised in 9/22 cases of AHT, compared to 1/30 cases of nAHT.  The overall OR for HII in association with AHT from the six studies was 4.19 (95% confidence interval 2.65-6.62; p=0.00001) 


Closed head injury

13 studies 1,3,4,6,7,10-13,16-19 analysed the prevalence of closed head injury, i.e. intracranial injury in the absence of skull fracture, and an updated meta analysis showed a very significant association with AHT, OR 4.96 (95% confidence interval 3.44-7.15;p<0.00001) 


Click here to open


  1. Adamo MA, Drazin D, Smith C, Waldman JB. Comparison of accidental and nonaccidental traumatic brain injuries in infants and toddlers: demographics, neurosurgical interventions, and outcomes. Journal of Neurosurgery: Pediatrics. 2009;4(5):414-419 [Pubmed]
  2. Datta S, Stoodley N, Jayawant S, Renowden S, Kemp A. Neuroradiological aspects of subdural haemorrhages. Archives of Disease in Childhood. 2005;90(9):947-951 [Pubmed]
  3. Diaz-Olavarrieta C, Garcia-Pina CA, Loredo-Abdala A, Paz F, Garcia S.G, Schilmann A. Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study. Child Abuse & Neglect. 2011;35(11):915-923 [Pubmed]

  4. Ettaro L, Berger RP, Songer T. Abusive head trauma in young children: characteristics and medical charges in a hospitalized population. Child Abuse and Neglect. 2004;28(10):1099-1111 [Pubmed]
  5. Ewing-Cobbs L, Prasad M, Kramer L, Louis PT, Baumgartner J, Fletcher JM, Alpert B. Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Child's Nervous System. 2000;16(1):25-33, discussion 34 [Pubmed]
  6. Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108(3):636-646 [Pubmed]
  7. Goldstein B, Kelly MM, Bruton D, Cox C. Inflicted versus accidental head injury in critically injured children. Critical Care Medicine. 1993;21(9):1328-1332 [Pubmed]
  8. Hettler J, Greenes DS. Can the initial history predict whether a child with a head injury has been abused? Pediatrics 2003;111(3):602-607 [Pubmed]
  9. Hymel KP, Rumack CM, Hay TC, Strain JD, Jenny C. Comparison of intracranial computed tomographic (CT) findings in pediatric abusive and accidental head trauma. Pediatric Radiology. 1997;27(9):743-747 [Pubmed]
  10. Hymel KP, Willson DF, Boos SC, Pullin DA, Homa K, Lorenz DJ, Herman BE, Graf JM, Isaac R, Armijo-Garcia V, Narang SK, Pediatric Brain Injury Research Network (PediBIRN) Investigators. Derivation of a clinical prediction rule for pediatric abusive head trauma. Pediatric Critical Care Medicine. 2013;14(2):210-220. [Pubmed]

  11. Ichord RN, Naim M, Pollock AN, Nance ML, Margulies SS, Christian CW. Hypoxic-ischemic injury complicates inflicted and accidental traumatic brain injury in young children: the role of diffusion-weighted imaging. Journal of Neurotrauma. 2007;24(1):106-118. [Pubmed]
  12. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF. A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics. 2004;114(3):633-639 [Pubmed]
  13. Kelly P, Hayes I. Infantile subdural haematoma in Auckland, New Zealand: 1988-1998. New Zealand Medical Journal. 2004;117(1201):U1047 [Pubmed]
  14. McKinney AM, Thompson LR, Truwitt CL, Velders S, Karagulle A, Kiragu A. Unilateral hypoxic-ischemic injury in young children from abusive head trauma, lacking craniocervical vascular dissection or cord injury. Pediatric Radiology. 2008;38(2):164-174 [Pubmed]
  15. Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Archives of Pediatrics and Adolescent Medicine. 2000;154(1):11-15 [Pubmed]
  16. Thalayasingam M, Veerakumarasivam A, Kulanthayan S, Khairuddin F, Cheah IGS. Clinical clues for head injuries amongst Malaysian infants: Accidental or non-accidental? Injury, International Journal of the Care of the Injured. 2012;43:2083-2087. [Pubmed]

  17. Tzioumi D, Oates RK. Subdural hematomas in children under 2 years. Accidental or inflicted? A 10-year experience. Child Abuse and Neglect. 1998;22(11):1105-1112 [Pubmed]
  18. Vinchon M, De Foort-Dhellemmes S, Desurmont M, Delestret I. Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases. Child's Nervous System. 2010;26(5):637-645. [Pubmed]

  19. Wells RG, Vetter C, Laud P. Intracranial hemorrhage in children younger than 3 years: prediction of intent. Archives of Pediatrics and Adolescent Medicine. 2002;156(3):252-257 [Pubmed]


^ back to top