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http://dx.doi.org/10.3340/jkns.2021.0289

Complex Pathophysiology of Abusive Head Trauma with Poor Neurological Outcome in Infants  

Park, Young Soo (Department of Neurosurgery and Children's Medical Center, Nara Medical University)
Publication Information
Journal of Korean Neurosurgical Society / v.65, no.3, 2022 , pp. 385-396 More about this Journal
Abstract
Abusive head trauma (AHT) in infants, especially acute subdural hematoma, has an extremely poor outcome. The most decisive and important finding is the appearance of a widespread low-density area on head computed tomography. This phenomenon was traditionally thought to be caused by cerebral ischemia. However, many other pathophysiological abnormalities have been found to be intricately involved. Recent studies have found that status epilepticus and hyperperfusion injures are the major causes. Another serious problem associated with AHT is cardiopulmonary arrest (CPA). Many infants are reported to visit to the hospital with CPA, and its pathophysiology has not been fully elucidated. This paper examines the background of these pathological conditions and associated factors and elucidate the pathophysiological mechanisms resulting in poor outcomes in AHT. In addition to the intensity of assault on the head, the peculiar pathophysiological characteristics in infants, as well as the social background specific to child abuse, are found to be associated with poor outcome.
Keywords
Child abuse; Acute subdural hematoma; Hypoxia-Ischemia; Outcome; Pathophysiology;
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1 Colombari M, Troakes C, Turrina S, Tagliaro F, De Leo D, Al-Sarraj S : Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT). Int J Legal Med 135 : 1481-1498, 2021   DOI
2 Eder HG, Legat JA, Gruber W : Traumatic brain stem lesions in children. Childs Nerv Syst 16 : 21-24, 2000   DOI
3 Figueira Rodrigues Vieira G, Guedes Correa JF : Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review. Neuroradiology 62 : 653-660, 2020   DOI
4 Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Ishii K, Kushimoto S, et al. : Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury. J Neurosurg 129 : 1317-1324, 2018   DOI
5 Karibe H, Kameyama M, Hayashi T, Narisawa A, Tominaga T : Acute subdural hematoma in infants with abusive head trauma: a literature review. Neurol Med Chir (Tokyo) 56 : 264-273, 2016   DOI
6 Kim HJ : The prognostic factors related to traumatic brain stem injury. J Korean Neurosurg Soc 51 : 24-30, 2012   DOI
7 Lee WJ, Lim YC, Yoon SH : Abusive head traumas in 4 infants. Korean J Neurotrauma 16 : 246-253, 2020   DOI
8 Foster KA, Recker MJ, Lee PS, Bell MJ, Tyler-Kabara EC : Factors associated with hemispheric hypodensity after subdural hematoma following abusive head trauma in children. J Neurotrauma 31 : 1625-1631, 2014   DOI
9 Greeley CS : Abusive head trauma: a review of the evidence base. AJR Am J Roentgenol 204 : 967-973, 2015   DOI
10 Duhaime AC, Bilaniuk L, Zimmerman R : The "big black brain": radiographic changes after severe inflicted head injury in infancy. J Neurotrauma 10(Suppl 1) : S59, 1993
11 Gennarelli TA, Thibault LE, Adams JH, Graham DI, Thompson CJ, Marcincin RP : Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 12 : 564-574, 1982   DOI
12 Gerber P, Coffman K : Nonaccidental head trauma in infants. Childs Nerv Syst 23 : 499-507, 2007   DOI
13 Graupman P, Winston KR : Nonaccidental head trauma as a cause of childhood death. J Neurosurg 104(4 Suppl) : 245-250, 2006
14 Adamsbaum C, Grabar S, Mejean N, Rey-Salmon C : Abusive head trauma: judicial admissions highlight violent and repetitive shaking. Pediatrics 126 : 546-555, 2010   DOI
15 Pang D : Spinal cord injury without radiographic abnormality in children, 2 decades later. Neurosurgery 55 : 1325-1342; discussion 1342-1343, 2004   DOI
16 Khan NR, Fraser BD, Nguyen V, Moore K, Boop S, Vaughn BN, et al. : Pediatric abusive head trauma and stroke. J Neurosurg Pediatr 20 : 183-190, 2017   DOI
17 O'Neill BR, Handler MH, Tong S, Chapman KE : Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children. J Neurosurg Pediatr 16 : 167-176, 2015   DOI
18 Christian CW, Block R; Committee on Child Abuse and Neglect; American Academy of Pediatrics : Abusive head trauma in infants and children. Pediatrics 123 : 1409-1411, 2009   DOI
19 Altman RL, Canter J, Patrick PA, Daley N, Butt NK, Brand DA : Parent education by maternity nurses and prevention of abusive head trauma. Pediatrics 128 : e1164-e1172, 2011   DOI
20 Abu Hamdeh S, Marklund N, Lewen A, Howells T, Raininko R, Wikstrom J, et al. : Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures. J Neurosurg 131 : 604-611, 2018   DOI
21 Arndt DH, Lerner JT, Matsumoto JH, Madikians A, Yudovin S, Valino H, et al. : Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort. Epilepsia 54 : 1780-1788, 2013   DOI
22 Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK, et al. : Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48 : 1048-1065, 2018   DOI
23 Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR : Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 15 : 49-59, 1989   DOI
24 Duhaime AC, Durham S : Traumatic brain injury in infants: the phenomenon of subdural hemorrhage with hemispheric hypodensity ("big black brain"). Prog Brain Res 161 : 293-302, 2007   DOI
25 Cordobes F, Lobato RD, Rivas JJ, Portillo JM, Sarabia M, Munoz MJ : Post-traumatic diffuse brain swelling: isolated or associated with cerebral axonal injury. Clinical course and intracranial pressure in 18 children. Childs Nerv Syst 3 : 235-238, 1987   DOI
26 Costine-Bartell BA, McGuone D, Price G, Crawford E, Keeley KL, MunozPareja J, et al. : Development of a model of hemispheric hypodensity ("big black brain"). J Neurotrauma 36 : 815-833, 2019   DOI
27 Wong AM, Yeh CH, Liu HL, Wu TW, Lin KL, Wang HS, et al. : Arterial spin-labeling perfusion imaging of children with subdural hemorrhage: perfusion abnormalities in abusive head trauma. J Neuroradiol 44 : 281-287, 2017   DOI
28 Dias MS, Rottmund CM, Cappos KM, Reed ME, Wang M, Stetter C, et al. : Association of a postnatal parent education program for abusive head trauma with subsequent pediatric abusive head trauma hospitalization rates. JAMA Pediatr 171 : 223-229, 2017   DOI
29 Dias MS, Smith K, DeGuehery K, Mazur P, Li V, Shaffer ML : Preventing abusive head trauma among infants and young children: a hospitalbased, parent education program. Pediatrics 115 : e470-e477, 2005   DOI
30 Duhaime AC, Christian C, Moss E, Seidl T : Long-term outcome in infants with the shaking-impact syndrome. Pediatr Neurosurg 24 : 292-298, 1996   DOI
31 Brown RL, Brunn MA, Garcia VF : Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 36 : 1107-1114, 2001   DOI
32 Paek D, Kwon DI : A review on four different paths to respiratory arrest from brain injury in children; implications for child abuse. J Forensic Leg Med 71 : 101938, 2020   DOI
33 Visocchi M, Chiaretti A, Genovese O, Di Rocco F : Haemodynamic patterns in children with posttraumatic diffuse brain swelling. A preliminary study in 6 cases with neuroradiological features consistent with diffuse axonal injury. Acta Neurochir (Wien) 149 : 347-356, 2007   DOI
34 Duhaime AC, Christian CW : Abusive head trauma: evidence, obfuscation, and informed management. J Neurosurg Pediatr 24 : 481-488, 2019   DOI
35 Duhaime AC, Christian CW, Rorke LB, Zimmerman RA : Nonaccidental head injury in infants--the "shaken-baby syndrome". N Engl J Med 338 : 1822-1829, 1988
36 Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Kato Y, Tatewaki Y, et al. : Intraventricular hemorrhage on initial computed tomography as marker of diffuse axonal injury after traumatic brain injury. J Neurotrauma 32 : 359-365, 2015   DOI
37 Moen KG, Brezova V, Skandsen T, Haberg AK, Folvik M, Vik A : Traumatic axonal injury: the prognostic value of lesion load in corpus callosum, brain stem, and thalamus in different magnetic resonance imaging sequences. J Neurotrauma 31 : 1486-1496, 2014   DOI
38 Narang SK, Estrada C, Greenberg S, Lindberg D : Acceptance of shaken baby syndrome and abusive head trauma as medical diagnoses. J Pediatr 177 : 273-278, 2016   DOI
39 Narang SK, Fingarson A, Lukefahr J; COUNCIL ON CHILD ABUSE AND NEGLECT : Abusive head trauma in infants and children. Pediatrics 145 : e20200203, 2020   DOI
40 Piteau SJ, Ward MG, Barrowman NJ, Plint AC : Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: a systematic review. Pediatrics 130 : 315-323, 2012   DOI
41 Yokobori S, Nakae R, Yokota H, Spurlock MS, Mondello S, Gajavelli S, et al. : Subdural hematoma decompression model: a model of traumatic brain injury with ischemic-reperfusional pathophysiology: a review of the literature. Behav Brain Res 15 : 23-28, 2018
42 Greiner MV, Greiner HM, Care MM, Owens D, Shapiro R, Holland K : Adding insult to injury: nonconvulsive seizures in abusive head trauma. J Child Neurol 30 : 1778-1784, 2015   DOI
43 Rongchao S, Shudong Y, Zhiyi Z : Pathological and immunohistochemical study of lethal primary brain stem injuries. Diagn Pathol 7 : 54, 2012   DOI
44 Zimmerman RA, Bilaniuk LT, Farina L : Non-accidental brain trauma in infants: diffusion imaging, contributions to understanding the injury process. J Neuroradiol 34 : 109-114, 2007   DOI
45 Hasbani DM, Topjian AA, Friess SH, Kilbaugh TJ, Berg RA, Christian CW, et al. : Nonconvulsive electrographic seizures are common in children with abusive head trauma*. Pediatr Crit Care Med 14 : 709-715, 2013   DOI
46 Onuma T, Shimosegawa Y, Kameyama M, Arai H, Ishii K : Clinicopathological investigation of gyral high density on computerized tomography following severe head injury in children. J Neurosurg 82 : 995-1001, 1995   DOI
47 Pang D, Wilberger JE Jr : Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57 : 114-129, 1982   DOI