Non-accidental injury - intracranial injuries and skull fracture

Case contributed by Tony Lamont


Unconscious infant brought to casualty by ambulance. Child stopped breathing at home.

Patient Data

Age: 3 months
Gender: Female

Multiple complex fractures of the skull predominantly on the left parietal region extending into occipital bone. Significant diastasis of the fracture and sutures.

Two selected non-contrast enhanced CT studies showing extensive localized cerebral edema in the left hemisphere and in the frontal lobe of the right hemisphere. Midline shift to the right. Subdural hemorrhage related to the fracture site. Scalp hematoma.

Selected T1 axial and T2 Coronal images of the infant performed three days after admission. Gross left cerebral edema is shown with transtentorial and subfalcine herniation. The subdural collection is again shown.

Case Discussion

Parental explanation for this injury was that the child fell from the father's knees and bumped her head on a coffee table. There was a five hour delay before emergency services were called because the infant stopped breathing. It was not felt that the injuries were consistent with the given history. The patient was admitted to ICU and survived four days on intensive treatment before succumbing to injuries.

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