The Abusive Head Trauma: Case Report and Neurological Follow-Up

Aims: Retrospective case reports and neurological follow-up of the abusive head trauma (AHT) through evidence-based anamnestic, radiologic, ophthalmologic, and clinical features.

Methods: Data comes from 540 cases of child abuse discussed by the children's protection group from 2005 to 2013. Overall, 10 cases of AHT were included. The case reports are based on results and combinations of the results that are considered significantly associated with the AHT by a great number of systematic reviews. The neurological follow-up includes neurological status, Griffiths score, and neuroimaging.

Results: Overall, six girls and four boys with a mean age of 4.1 months (range, 1–13 months) presented an AHT. They showed following results significantly associated with the AHT: no adequate history (8/10), subdural hemorrhage (8/10; thereof 8/8 multiple, 8/8 convexity, and 4/8 interhemispheric hemorrhages), retinal hemorrhage (6/10; thereof 5/6 multiple, 4/6 preretinal, 4/6 multilayered, and 3/6 bilateral), hypoxic–ischemic injury (5/10; thereof 5/5 with subcortical injury), seizure (5/10), cerebral edema (4/10), rib fracture (3/10), skull fracture plus intracranial injury (3/10), metaphyseal fracture (2/10), apnoea (1/10), and optic nerve sheath hemorrhage (1/10). Overall, six cases presented a combination of features highly probable for AHT. In four cases, the neurological follow-up was possible and showed a moderate outcome.

Conclusion: Because of the wide range of possible features, the diagnosis of AHT is a difficult issue. Whenever the pattern of lesion does not match with the history of trauma, it is strongly recommended to initiate further investigations. Radiologic and ophthalmologic features can raise both sensibility and specificity of the diagnosis of AHT, if they are described adequately. Most of the clinical features are not specific, except they occur in particular combinations. It is important that pediatricians are aware of these discrepancies.