Friday, January 26, 2024

In the physically abused child.. C.T. is the imaging of choice in the abused child with acute head injury

In the physically abused child:

  • A- Extradural haematoma is more common than subdural. (Subdural is more common in infants 80%)
  • B- Cross section imaging of the brain is required in all cases.
  • C- C.T. is the imaging of choice in the abused child with acute head injury.
  • D- U/S of infants' brain reveals more lesions than C.T.
  • E- Serious cerebral injury is rare in the absence of skull fracture.

Physical Abuse in Children and Brain Injuries:

A. Extradural hematoma vs. Subdural hematoma:


Contrary to the statement, subdural hematoma is more common than extradural hematoma in physically abused children, especially in infants (around 80% of cases). This is because the brain of an infant is more vulnerable due to its softer consistency and weaker dural attachments.

B. Cross-sectional imaging of the brain:

Partially correct:

While cross-sectional imaging like CT scan or MRI is crucial in diagnosing brain injuries in abused children, it's not always required in all cases. Depending on the severity of symptoms and clinical presentation, other examinations like neurological assessments or X-rays might be sufficient for initial evaluation.

C. CT scan vs. MRI:


While CT scan used to be the preferred imaging modality due to its faster acquisition time, MRI has become the gold standard for brain imaging in abused children. This is because MRI offers superior soft tissue resolution and can detect subtle injuries like diffuse axonal injury that might be missed on CT scans.

D. Ultrasound vs. CT scan:


Ultrasound is generally not as sensitive as CT scan for detecting brain injuries, especially in older children. While it can be useful for rapidly assessing infants' brains due to its portability and non-invasive nature, it often misses subtle lesions compared to CT or MRI.

E. Skull fracture and serious cerebral injury:


Although skull fractures can be a sign of significant force and raise concerns about potential brain injury, their absence doesn't rule out serious cerebral damage. Shaken baby syndrome, for example, can cause severe brain injuries without any skull fractures.

Additional points:

  • Physical abuse can cause a variety of brain injuries beyond hematomas, such as contusions, diffuse axonal injury, and cerebral edema.
  • Early diagnosis and intervention are crucial for minimizing long-term consequences of brain injuries in abused children.
  • A multidisciplinary approach involving medical professionals, social workers, and legal authorities is essential for managing cases of child abuse.