High-resolution cranial ultrasound in the shaken-baby syndrome |
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Authors: | Chen C Y Huang C C Zimmerman R A Yuh Y S Chen S J Chin S C Lee C C Lee K W |
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Institution: | (1) Department of Radiology, Tri-Service General Hospital and National Defence Medical Centre, No. 325, Section 2, Cheng-Kung Road, Neihu, Taipei, Taiwan, Republic of China e-mail: sandy@m2.dj.net.tw Tel.: 8 86-2-87 92 72 44 Fax: 8 86-2-87 92 72 45, TW;(2) Department of Paediatrics, Tri-Service General Hospital and National Defence Medical Centre, No. 325, Section 2, Chung-Kung Road, Neihu, Taipei, Taiwan, Republic of China, TW;(3) Department of Paediatrics, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan 704, Taiwan, Republic of China, TW;(4) Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA, US |
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Abstract: | With limited near-field resolution and accessible acoustic windows, sonography has not been advocated for assessing central
nervous system injuries in the shaken-baby syndrome. Our purpose was to correlate high-resolution ultrasonographic characteristics
of central nervous system injuries in whiplash injuries and the shaken-baby-syndrome with MRI and CT. Ultrasonographic images
of 13 infants, aged 2–12 months, with whiplash or shaking cranial trauma were reviewed and compared with MRI in 10 and CT
in 10. Five patients had serial ultrasonography and MRI or CT follow-up from 1 to 4 months after the initial injury. With
ultrasonography we identified 20 subdural haematomas. MRI and CT in 15 of these showed that four were hyperechoic in the acute
stage, three were mildly echogenic in the subacute stage, and that one subacute and seven chronic lesions were echo-free.
Five patients had acute focal or diffuse echogenic cortical oedema which evolved into subacute subcortical hyperechoic haemorrhage
in four, and well-defined chronic sonolucent cystic or noncystic encephalomalacia was seen at follow-up in two. Using ultrasonography
we were unable to detect two posterior cranial fossa subdural haematomas or subarachnoid haemorrhage in the basal cisterns
in three cases, but did show blood in the interhemispheric cistern and convexity sulci in two. Ultrasonography has limitations
in demonstrating abnormalities remote from the high cerebral convexities but may be a useful adjunct to CT and MRI in monitoring
the progression of central nervous system injuries in infants receiving intensive care.
Received: 25 October 2000 Accepted: 25 October 2000 |
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Keywords: | Nonaccidental injury Shaken-baby syndrome Sonography |
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