IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Non-accidental brain injury

Case contributed by Michał Czerny
Diagnosis certain

Presentation

This 5-month-old boy was admitted the hospital in a bad general and neurological condition with unclear causes. He was transferred and treated in the ICU. After an improvement and developing epileptic seizures treated at the neurological ward. The child was taken from an alcoholic mother and raised in a foster family.

Patient Data

Age: 5-month-old
Gender: Male

CT on admission

ct

CT presenting bilateral subdural hematomas (to be easily confused with hygromas) and a left sided parietal bone fracture. 

mri

Brain MR revealed bilateral chronic subdural hematomas with different ages, highly suggesting non-accidental injury.

The one on the right is most likely old with advanced evolvement and signal close to CSF. Low/ intermediate signal on T1WI and high/ intermediate signal on the left indicates less advanced evolvement to be differentiated with high-protein content. 

In addition, there are areas of occipital brain contusion, bigger on the left. After admitting contrast media these areas have some cortical enhancement. 

On DWI (not shown) diffusion restriction was visible in the splenium of the corpus callosum indicating axonal injury. 

Case Discussion

This case emphasizes the need to be aware of non-accidental traumas in children. History supported the diagnosis, as the foster parents didn't show any concern for baby's condition, possible outcome and so on.

Neurologists interviewed the birth mum.  The information collected and imaging led to diagnosis and suspicion that trauma occurred under the foster parents' supervision. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.