Computed tomography of craniocerebral injury in the abused child.

Computed tomography (CT) was performed in 26 infants and children with craniocerebral trauma related to abuse during a 41-month period. The pattern of brain injury differed from that seen in the nonabused traumatized infant or child. Parieto-occipital acute interhemispheric subdural hematoma (AIHSH) with associated parenchymal injury was the most frequent finding (58%). Follow-up by CT in patients with AIHSH demonstrated infarction in half and cerebral atrophy in all.     

成人外伤性脑梗死的CT诊断

目的 探讨成人外伤性脑梗死的影像特点.方法 分析30例成人外伤性脑梗死的临床与CT资料.结果 脑叶梗死17例,基底节-内囊区梗死13例,伴蛛网膜下腔出血15例,硬膜下血肿9例,硬膜外血肿3例,脑内血肿3例,脑疝5例,出血性脑梗死2例.结论 CT发现成人外伤性脑梗死的最佳时间是外伤后24 h～6 d,梗死多伴有颅脑损伤的其他CT表现,临床结合动态CT观察是诊断成人外伤性脑梗死的有效方法.     

CT of bowel and mesenteric trauma in children.

Although most traumatic abdominal injuries in children are treated with conservative nonsurgical management, traumatic perforation or infarction of the gastrointestinal tract still necessitates surgical management. It is imperative to recognize the often subtle computed tomographic (CT) findings of bowel or mesenteric trauma in children. Pediatric patients with bowel perforation or infarction due to trauma usually demonstrate multiple abnormalities at CT. A specific history of lap belt injury, bicycle handlebar injury, or child abuse with an abdominal injury should heighten suspicion for a bowel injury. CT findings in children with bowel or mesenteric trauma include free intraperitoneal air, free retroperitoneal air, extraluminal oral contrast material, free intraperitoneal fluid, bowel wall defect, bowel wall thickening, mesenteric stranding, fluid at the mesenteric root, focal hematoma, active hemorrhage, and mesenteric pseudoaneurysm. Some findings, such as free intraperitoneal air and focal bowel wall thickening, are associated with a strong likelihood of a bowel injury that requires surgical repair. Other findings, such as free intraperitoneal fluid, mesenteric stranding, fluid at the mesenteric root, and focal hematoma, are less specific for an injury that requires surgical repair. The hypoperfusion complex can usually be differentiated from a traumatic bowel injury; however, in some patients the imaging findings overlap.     

Cranial imaging in child abuse

Serious head injury in children less than 2 years old is often the result of child abuse. The role of the different neuroimaging modalities in child abuse is reviewed. Skull X-ray and cranial CT are mandatory. Repeat or serial imaging may be necessary and brain MR imaging may contribute to the diagnostic work-up, particularly in the absence of characteristic CT findings. The radiologist plays an important role in accurately identifying non-accidental cranial trauma. The clinical presentation can be non-specific or misleading. The possibility should be considered of a combined mechanism, i.e., an underlying condition with superimposed trauma. In this context, the radiologist is in the front line to suggest the possibility of child abuse. It is therefore important to know the spectrum of, sometimes subtle, imaging findings one may encounter. Ophthalmological examination is of the greatest importance and is discussed here, because the combination of retinal hemorrhages and subdural hematoma is very suggestive of non-accidental cranial trauma.     

Meningioma presenting as an acute subdural hematoma

Most subdural hematomas occur as a sequel of trauma. Non-traumatic subdural hematomas may be found in patients with ruptured aneurysm, arteriovenous malformation, dural arteriovenous fistula, amyloid angiopathy, renal insufficiency, and cocaine abuse. Hypervascular primary and metastatic tumors may also present with subdural hematomas. We present the MR imaging features in a patient who presented with an acute subdural hematoma presumably caused by an underlying meningioma.     

Resolving duodenal-jejunal hematoma in abused children

Acute intramural duodenal-jejunal hematoma is a classical finding in the battered child syndrome. The radiographic findings of a large obstructing intramural mass associated with the "coiled-spring" appearance generally raise the question of child abuse in any patient without appropriate accidental injury. In this study the radiologic features of resolving duodenal-jejunal hematoma are detailed in five abused children. The results show that the coiled-spring appearance is an acute phenomenon associated with a well-localized intramural hematoma. In the resolving phase, localized mural masses in the lateral aspect of the descending duodenum and fold thickening are indications of prior intramural hemorrhage. When these radiologic features are encountered in a child with nonspecific abdominal complaints, child abuse should be suspected. Furthermore, in patients with suspected occult trauma, resolution of abdominal symptoms should not deter the radiologist from performing an upper gastrointestinal tract series, which may provide evidence of child abuse.     

非常见部位急性硬膜下血肿CT诊断(附26例报告)

目的　提高对非常见部位急性硬膜下血肿CT表现的认识。方法　头颅外伤后在 2 4h内行CT检查 1 9例 ,2～ 3d内行CT检查 7例。经治疗后在 1～ 4周内复查CT。结果　单纯表现为大脑镰急性硬膜下血肿 7例 ,小脑幕急性硬膜下血肿 5例。额颞底部急性硬膜下血肿 2例。脑挫裂伤、脑内血肿伴有大脑镰急性硬膜下血肿 3例 ,伴有小脑幕急性硬膜下血肿 2例 ,颞顶部急性硬膜下血肿伴有大脑镰急性硬膜下血肿 2例 ,大脑镰、小脑幕急性硬膜下血肿伴有蛛网膜下腔出血 5例。 2 6例大脑镰与小脑幕急性硬膜下血肿均发生在单侧。大脑镰急性硬膜下血肿的形态有的在中线呈细线状 ,有的呈粗线状。血肿厚度 0 .3～ 1 .5cm不等。小脑幕急性硬膜下血肿表现为片状、新月形。结论　大脑镰、小脑幕和额颞底部急性硬膜下血肿是发生在少见部位的特殊类型急性硬膜下血肿 ,只要对此类血肿有所认识 ,CT检查不难确诊 ,但有时需要与蛛网膜下腔出血鉴别     

成人颅脑损伤并发脑梗死的影响因素分析

目的探讨成人颅脑损伤后并发脑梗死的发生率并分析其影响因素。方法对580例成人颅脑损伤患者损伤后发生脑梗死的发生情况进行回顾性分析,应用相关统计学分析方法分析颅脑损伤后并发脑梗死与其各影响因素之间的关系。结果 580例颅脑损伤患者并发脑梗死者32例,发生率5.5%;高龄、GCS〈8分、脑疝、低血压、脑挫裂伤、硬膜下血肿、蛛网膜下腔出血、脱水剂及活血药物的使用与脑梗死的发生有密切关系（P〈0.05）。结论成人颅脑损伤后脑梗死发生率高,高龄、GCS〈8分、脑疝、低血压、脑挫裂伤、硬膜下血肿、蛛网膜下腔出血、脱水剂及活血药物的使用为影响因素。     

Post-traumatic cerebral infarction. Neuroimaging findings, etiology and outcome

Purpose: To assess the radiological characteristics of post-traumatic cerebral infarctions (PTCIs), the etiology and site of infarction, and to provide neuroimaging indicators of a poor clinical outcome.Material and Methods: A retrospective study of 16 patients with the neuroimaging-based diagnosis of PTCI was carried out. All CT, MR examinations, cerebral angiograms and medical records of the patients were reviewed.Results: Infarcts were diagnosed in the territory of the posterior cerebral artery in 9 patients, in the middle cerebral artery in 5, in the anterior cerebral artery in 3, lenticulostriate-thalamoperforating in 2, vertebrobasilar in 3, and cortical infarcts in 2 patients. Neuroimaging studies suggested focal mass effect and/or acquired intracranial herniations as the cause of infarction in 13/16 patients (81.2%). In 3/16 patients (18.8%), PTCI was due to vascular injury of which 2 were angiographically documented (carotid artery dissection). Eight of the 16 patients in this study died or were left in a persistent vegetative state. Patients with associated subdural hematoma, brain swelling/edema and traumatic subarachnoid hemorrhage (tSAH) exhibited the worst outcome.Conclusion: Gross mechanical shift of the brain and herniation across the falx and/or tentorium accounted for infarction in a majority of cases in our study. The overall death rate was 43.8% and this result suggests that PTCI is an indication of a poor clinical outcome, especially among patients with associated subdural hematoma, brain swelling/edema and tSAH.     

颅脑减速伤的损伤特点研究

目的研究颅脑减速伤的损伤特点,探讨其在颅脑创伤的伤情判断和影像诊断中的应用价值。方法分析361例临床典型颅脑减速伤患者的颅脑CT影像资料,结合致伤病史及临床资料,总结归纳颅脑减速伤的损伤特点。结果颅脑减速伤损伤的主要特点为:撞击部位头皮损伤、颅盖骨折、硬膜外血肿、硬膜下血肿和脑挫裂伤,对冲部位硬膜下血肿、颅底骨折和脑挫裂伤;颅骨骨折以撞击部位多见,硬膜下血肿以对冲部位多见,蛛网膜下腔出血主要位于脑底部及脑挫裂伤区;额、颞叶严重对冲伤是常见颅脑减速伤的重要特征。结论根据颅脑减速伤的损伤特点,结合致伤病史或颅脑CT表现,可为临床颅脑减速伤伤情的快速判断与救治、CT扫描及诊断、创伤事故原因的评判提供理论依据。     

Subdural hematomas due to ruptured cerebral aneurysms: angiographic diagnosis and potential pitfall for CT.

Two patients with subdural hematoma secondary to rupture of intracranial aneurysms are described. Computed tomography and plain skull films are generally the examination of choice for the patient with significant head trauma. In selected patients, however, cerebral angiography in place of, or along with, computed tomography may be necessary to demonstrate an underlying cause for the subdural hematoma.     

婴儿晚发性维生素K依赖因子缺乏症的脑CT临床研究

目的：研究婴儿晚发性维生素K依赖因子缺乏症患儿颅内CT形态学改变的特点。材料和方法：对50例婴儿晚发性维生素K依赖因子缺乏症的患儿进行了头部CT检查，男33例，女17例，年龄27天-3月，并对其结果进行了分析。结果：48例颅脑CT异常，表现为（1）脑实质血肿28例，蛛网膜下腔出血45例，硬膜下出血38例，脑室内血肿3例。（2）弥漫性脑水肿、梗塞，单侧31例，双侧8例。（3）一侧脑室受压闭塞，对侧脑室扩张积水35例。（4）大脑镰下疝38例，小脑幕下疝28例。（5）复查28例存活患儿脑软化15例，脑积水13例，脑萎缩20例，颅板发育不良18例，正常6例。结论：CT对婴儿晚发性维生素K依赖因子缺乏症的早期诊断及预后判定具有肯定价值。     

急性大脑镰和小脑幕硬膜下血肿的CT及磁共振成像诊断

目的探讨急性大脑镰和小脑幕硬膜下血肿的CT及磁共振成像特征。方法回顾性分析17例急性大脑镰和小脑幕硬膜下血肿的CT及磁共振成像表现。结果 17例急性大脑镰和小脑幕硬膜下血肿中,大脑镰硬膜下血肿5例,小脑幕硬膜下血肿7例,大脑镰并小脑幕硬膜下血肿5例,6例伴有颅盖骨(大脑凸面)部位的硬膜下血肿或脑实质挫裂伤。结论急性大脑镰和小脑幕硬膜下血肿较少见,易误诊为蛛网膜下腔出血、大脑镰钙化,CT和磁共振成像征象具特征性,有助于鉴别。     

晚发性维生素K缺乏致颅内出血的CT表现及临床意义探讨

目的：探讨晚发性维生素Ｋ缺乏致颅内出血的ＣＴ诊断、疗效观察及预后判断。材料与方法：对８年间所诊断的８４例患儿临床资料及ＣＴ资料进行回顾性分析。结果：ＣＴ显示颅内出血率为９０．５％，蛛网膜下腔出血最多见，其次为硬是出血、脑内出血，脑室内出血少见；有２个以上出血部位者占６１．９％，可出现大片脑梗褰主脑缺氧缺血性病变。硬膜下血肿及蛛网膜下腔出血吸较完全，脑内血肿范围较大，特别是伴胸有成竹离梗塞得可有脑国     

Magnetic resonance applications in cerebral injury.

CT and MR imaging are complementary in the evaluation of cerebral head trauma. CT is still more useful for the initial evaluation of the acutely unstable patient who has a head injury. However, many lesions are identified by MR imaging such as cortical contusions, small subdural hematomas, and diffuse axonal injuries that may not be seen on CT examinations. In addition, MR angiography can play an important role in the diagnostic evaluation of the trauma patient. MR angiography can be clinically useful in delineating vascular abnormalities such as arterial occlusions, arteriovenous fistulae, dissecting aneurysms, and venous sinus occlusion. In pediatric trauma, MR imaging appears to be superior to CT in assessing head injuries, particularly those due to child abuse.     

Investigating the possibility and probability of perinatal subdural hematoma progressing to chronic subdural hematoma,with and without complications,in neonates,and its potential relationship to the misdiagnosis of abusive head trauma

The high incidence of subdural hematoma (SDH) from birthing was first identified with MRI by Looney in 2007 and was then more accurately determined by Rooks in 2008. Rooks screened 101 “normal” deliveries and demonstrated that 46% of the babies in her series and by inference, approximately 46% of the 4 million born normally in the US have SDH that formed in the perinatal (birthing) period during labor. Both metabolic strain and physical forces exerted on the head damage the capillaries within the dura (the intradural capillary bed), which is the source of the blood in the SDH that results from labor and delivery or at times from labor alone. While child abuse pediatricians relying on Rooks, maintain that no permanent complications result, her study was limited to 101 subjects and the sole criteria for resolution was the resolution of the SDH as seen on follow-up MRI. In fact, Rooks did have one patient (1%) who had complications that lead to symptoms and findings often associated with abuse. The purpose of this article is to explore if there is a complication rate for perinatal (PSDH) that supports that 1% of complications that are definable by different criteria. Next, if there are complications, how many of the roughly 2,000,000 cases of perinatal acute subdural hematoma every year in the United States will suffer them? Then, what are the clinical manifestations of the complications if they occur? Lastly, do the complications cause or mimic some or all of the findings that are offered by board certified child abuse pediatricians as evidence of child abuse? The article argues that a small percentage, but significant number of neonates, suffer birth related complications and findings secondary to the development of chronic subdural hematoma CSDH) that are often misdiagnosed as abusive head trauma.     

Age determination of subdural hematomas: survey among radiologists

Abusive head trauma is a severe form of child abuse. One important diagnostic finding is the presence of a subdural hematoma. Age determination of subdural hematomas is important to relate radiological findings to the clinical history presented by the caregivers. In court this topic is relevant as dating subdural hematomas can lead to identification of a suspect. The aim of our study is to describe the current practice among radiologists in the Netherlands regarding the age determination of subdural hematomas in children. This is a cross-sectional study, describing the results of an online questionnaire regarding dating subdural hematomas among pediatric and neuro-radiologists in the Netherlands. The questionnaire consisted of sociodemographic questions, theoretical questions and eight pediatric cases in which the participants were asked to date subdural hematomas based on imaging findings. Fifty-one out of 172 radiologists (30 %) filled out the questionnaire. The percentage of participants that reported it was possible to date the subdural hematoma varied between 58 and 90 % for the eight different cases. In four of eight cases (50 %), the age of the subdural hematoma as known from clinical history fell within the range reported by the participants. None of the participants was “very certain” of their age determination. The results demonstrate that there is a considerable practice variation among Dutch radiologists regarding the age determination of subdural hematomas. This implicates that dating of subdural hematomas is not suitable to use in court, as no uniformity among experts exists.     

Subdural hematoma in the setting of internal carotid artery occlusion: CT studies

A 72-year-old woman with previously symptomatic internal carotid artery occlusion subsequently presented with an acute hemispheric deficit. The patient was initially diagnosed as having an ischemic infarction but eventually was shown to have a subacute subdural hematoma with delay in surgical evacuation and a major permanent deficit. We speculate that internal carotid artery occlusion may predispose the patient to greater morbidity from subdural hematoma. Patchy hemispheric infarction may reflect greater vulnerability to extrinsic hemispheric compression in the setting of carotid occlusion. This case illustrates the necessity for vigorous pursuit of the diagnosis of subdural hematoma in patients presumed to have transient ischemic attacks or acute cerebral infarction.     

大脑镰硬膜下血肿的CT诊断

目的评价CT对大脑镰硬膜下血肿诊断的可行性。方法回顾性分析25例具有完整资料的外伤性大脑镰硬膜下血肿的CT表现。结果25例中,14例表现细绳索状高密度影,11例表现粗绳索状高密度影;粗绳索状影近中线侧平直,外侧呈浅波浪状,其对应脑回受压远离中线,脑沟及纵裂池模糊或消失。结论大脑镰硬膜下血肿是硬膜下血肿的一种少见类型,通过分析CT征象,能够作出正确诊断。     

Influence of "optical illusion" on detectability in diagnosis for head CT images: participation of optical illusion of light perception in medical image reading and diagnosis

Even if the visual impression of the photographic density of the brain in head CT images is shown as physically the same, it is known that optical illusions of lightness perception (assimilation, contrast, picture frame effect, etc.) occur and that practical density can be observed psychologically differently, according to differences in the color of the skull and background, and differences in cases (differences in picture pattern). Therefore, in this study, in order to clarify the influence of optical illusion on detectability in diagnosis, the author attempted to compare detectability in four sample cases, consisting of acute cerebral infarction (1), acute epidural hematoma (1), and chronic subdural hematoma (2), using visual subjective evaluation. In the case of acute cerebral infarction, there was no significant difference in detectability between the original image and the virtual images. Further, it clarified that the original head CT image (acute epidural hematoma) with the high-density hematoma recognized at the marginal limited part of the brain was inferior to virtual images in detectability, while it clarified that the original head CT image (chronic subdural hematoma) with the low-density hematoma was superior to virtual images in detectability, because of visual psychological emphasis on the difference of the film contrast between the hematoma and white skull.