Non-accidental brain injury

Case contributed by Dr Michał Czerny

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

Modality: CT

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

Modality: 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 emphasises 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. 

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Case Information

rID: 42720
Case created: 4th Feb 2016
Last edited: 11th Dec 2016
Inclusion in quiz mode: Excluded
Excluded from licensing

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