Abusive head trauma: parenchymal injury

Physicians have an ethical and legal mandate to identify abused children so that they may be protected from further harm and are simultaneously required to think broadly and objectively about differential diagnoses. The medical literature is replete with examples of medical diseases that mimic abuse, potentially leading to misdiagnoses and subsequent harm to children and families. This review highlights some of the common and uncommon diseases that mimic physical and sexual abuse of children. Christian provides medical-legal expert work in child abuse cases. Published January 25, Accessed January 13, 2. The effects of childhood stress on health across the lifespan. Burden and consequences of child maltreatment in high-income countries. The mistaken diagnosis of child abuse: Mil Med ;

Subdural Hematoma

Uscinski described an experiment set up by A. Ommaya who “devised an experiment to measure more precisely the amount of rotational acceleration necessary to reach the threshold of injury. A contoured fiberglass chair was built, mounted on wheels, and placed on tracks with a piston behind it. Rhesus monkeys were strapped into the chair with their heads free to rotate.

A seizure, technically known as an epileptic seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with loss of consciousness (tonic-clonic seizure), to shaking movements involving only part of the body with variable levels of consciousness (focal seizure.

Your doctor may also order a blood test to check your complete blood count. A complete blood count test measures your red blood cell count, white blood cell count, and platelet count. A low level of red blood cells can indicate significant blood loss. Your doctor may also give you a physical examination to check your heart rate and blood pressure for evidence of internal bleeding. What are the treatment options for a subdural hematoma? An acute subdural hematoma can only be treated in an operating room.

A surgical procedure called a craniotomy may be used to remove a large subdural hematoma.

Diagnosis of MRI of Spine/Nerve Damage

I have an anxiety disorder on and off. This raises my BP readings. The risk here is sudden incapacitation. Still is a disqualifier.

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Facts about the brain: The brain contains around billion neurons. We have all our neurons when we are babies, but they aren’t yet connected as in an adult. Further, the brain is not fully myelinated until age years. This probably explains most developmental milestones, including those of Piaget. The brain has a great deal to do with our learning, thinking, mood, speech and behavior.


Arachnoid vessels closely relate to the cortical dural bridging veins and, therefore, when arachnoid vessels are torn, bridging veins are also commonly torn, leading to the combination of SAH and SDH Fig. Twenty-one-month-old child who returned from the babysitter lethargic and irritable. Note the high attenuation posterior paratorcular SDH arrowhead. Note the similarity of signal intensity between the subarachnoid and ventricular CSF. Note the hyperintensity of the peripheral chronic SDHs.

There were other findings supporting abuse.

Immunity tends to wane by 20 percent a month, leaving those who got their shot in August or September with less than desirable protection by the time they’re exposed.

Brain Contusions Simply explained, a brain contusion is a bruise of the brain tissue. Just like bruises that occur on other parts of the body, a brain contusion is caused by small blood vessel leaks. Because they involve structural brain damage, contusions are more serious than concussions. Get a Free Legal Evaluation Causes of Brain Contusions Brain contusions are most often caused by an impact to the head , such as those sustained in a car accident, a fall, or a sports-related accident.

In some cases the brain is injured right below the site of impact, while in other cases the injury occurs on the opposite side of the impact. Contusions are most often found in cortical tissue, in areas that are near sharp ridges on the inside of the skull, such as under the frontal and temporal lobes and on the root of the ocular orbit.

Signs and Symptoms Contusions can be very minor with few symptoms and little or no damage to the brain, or they can be quite severe. People with severe contusions often spend some time unconscious following the injury, and upon awaking are confused, tired, emotional, or agitated. More severe contusions lead to swelling in the brain, which can cause additional brain damage. Other symptoms of brain contusions may include:

Hard Lump Under Skin After a Bad Bruise

Lumpy Like any combination of these characteristics When you push on a hematoma, it may move around under the skin, feeling uncomfortable or even painful. Though these signs and symptoms may be disconcerting, they are not usually a cause for alarm. Usually, the body will eventually reabsorb the blood that formed the hematoma without any need for treatment.

Treatment for Bruising Bruises will generally heal on their own, but treatment may help a hematoma heal faster and in some cases, offer relief from any pain or discomfort. There are many ways to treat this issue , including: Applying a cold pack to the site of the bruise during the first hours.

Adequate oxygen is vital for the brain. Many factors can cause the brain to receive inadequate oxygen. When oxygen levels are significantly low for four minutes or longer, brain cells begin to die and after five minutes permanent anoxic brain injury can occur.

Hearing loss or hearing ringing tinnitus Blurred Vision Causes[ edit ] Subdural hematomas are most often caused by head injury , when rapidly changing velocities within the skull may stretch and tear small bridging veins. Subdural hematomas due to head injury are described as traumatic. Much more common than epidural hemorrhages , subdural hemorrhages generally result from shearing injuries due to various rotational or linear forces. Subdural hematoma is also commonly seen in the elderly and in alcoholics, who have evidence of cerebral atrophy.

Cerebral atrophy increases the length the bridging veins have to traverse between the two meningeal layers, hence increasing the likelihood of shearing forces causing a tear. It is also more common in patients on anticoagulants or antiplatelet drugs , such as warfarin and aspirin.

Chronic subdural hematomas: a review

Lumpy Like any combination of these characteristics When you push on a hematoma, it may move around under the skin, feeling uncomfortable or even painful. Though these signs and symptoms may be disconcerting, they are not usually a cause for alarm. Usually, the body will eventually reabsorb the blood that formed the hematoma without any need for treatment. Treatment for Bruising Bruises will generally heal on their own, but treatment may help a hematoma heal faster and in some cases, offer relief from any pain or discomfort.

Latest Medical Research about Brain Injury Updated: 13 July MAGNETIC RESONANCE SPECTROSCOPY (MRS) MRS is a new diagnostic tool to detect brain injury by looking at the levels of common brain chemicals after injury.

Pathogenesis, Diagnosis, and Forensic Implications. Because during neuroimaging we frequently observe the concomitant occurrence of hyper- and hypodense subdural collections mixed-density pattern , in both the same location and at least 2 different locations, we were interested in the possible pathophysiologic mechanisms that underlie the formation of the hypodense component ie, subdural hygromas [SDHys].

The currently available literature reveals the presence of the 2 major hypotheses that we outlined in our review article delayed and rapid formation of SDHys. Dating the incident by estimating the age or stage of a subdural collection is an even more controversial issue and has a high potential for confusion, especially the question of how many shaking events might have occurred. The infant had been clinically examined at relatively short intervals since birth, and the clinical records did not reveal any abnormalities 1 month before the MR imaging, in either cranial sonography or clinically.

We totally agree with the opinion that in the context of violent acceleration-deceleration, the occurrence of an acute SDHy without any hemorrhagic component or sediment could be considered unusual.

Hounsfield scale

Symptoms of physical abuse in children, especially infants, are often nonspecific and may overlap with numerous other clinical conditions. Therefore, radiologists play a key role in identifying imaging findings to make the diagnosis of physical child abuse. Although many injury patterns may be seen with both accidental and nonaccidental trauma, there are some characteristic findings and injury patterns of abuse that should be recognized by radiologists who interpret pediatric imaging studies.

This review covers the characteristic imaging manifestations of child abuse, as well as diagnostic pearls, pitfalls, and limitations associated with skeletal, intracranial, spinal, and abdominal injuries. Skeletal Injuries Aside from cutaneous findings, such as bruising and contusions, fractures are the next most common findings in abused children.

The ability to identify child abuse constitutes an important concern to those involved in the medical care of children. Studies show that at least 10% of children under 5 years old who are brought to the emergency room with alleged accidents have actually suffered nonaccidental trauma.

On April 11, , the Administration for Children’s Services hereinafter petitioner filed an Article 10 petition alleging, inter alia, that the respondent mother, Yvette E. The petition further alleges that neither parent had an explanation for the child’s injuries, and the injuries were consistent with abusive head trauma. The petition also alleges that the subject child, Joshua D.

The fact finding hearing in this matter commenced on April 28, and concluded on April 7, The Court ordered counsel to submit written summations. As a result of the abuse of Xavier, the subject child Joshua is abused or is in imminent danger of being abused, and a derivative finding of abuse is entered. The petitioner presented the testimony of child abuse specialist Dr. Jamie Hoffman-Rosenfeld hereinafter Dr.

Imaging in Child Abuse

It is important to note that in the cases of accidental head injury that were accompanied by retinal hemorrhages, there was a clear history of head trauma that was given by the caregivers when the child first presented for care. It is also noteworthy that the types of retinal hemorrhages present in children with accidental head injury were distinctly different from those present in children with abusive head injury in that they were confined to the intraretinal layer, did not cover the macula, and did not extend to the periphery of the retina.

Other studies have stated there is no clinical difference to differentiate between them. Why would there be a consistent difference? A logical answer would be that the second set of hemorrhages assumed to be from non-accidental injury may come from some other cause.

Shaken Baby Syndrome (SBS), also known as abusive head trauma or non-accidental injury, as an unscientific medical misdiagnosis, or medical myth, falsely-accused of SBS, wrongfully convicted of child abuse, alternative causes.

Subdural hematoma resulting from this procedure could present with vague symptoms such as chronic headache and could easily be missed. Chronic headache is one of the symptoms of chronic SDH in postpartum women. Diplopia as the presenting complaint in SDH secondary to peripartum spinal anesthesia has not, to our knowledge, been previously reported.

Here, we report a case of diplopia secondary to postpartum subacute bilateral SDHs with transtentorial herniation after spinal anesthesia in a healthy primagravid year-old woman. SDH can expand gradually and the initial symptoms might be subtle as in our case, despite critically high intracranial pressure. Such use was first described in Subdural hematoma SDH and abducens palsy are uncommon complications of spinal anesthesia.

She stated that she had delivered her first baby vaginally about 4 weeks before presentation, under spinal anesthesia. The entire pregnancy and peripartum period were uneventful except for moderate neck pain with stiffness and spasm starting shortly after delivery, for which she used ibuprofen every 6 hours for 2 to 3 days. The patient reported no headache, nausea, vomiting, change in vision, difficulty speaking, numbness, or weakness during that time.

Two weeks after delivery she started noticing double vision, which progressively worsened to the point where she was having difficulty driving her car. The review of systems was negative for fever, chills, chest pain, dyspnea, nausea, vomiting, abdominal pain, or urinary symptoms. She reported no recent or remote head trauma as well as no bleeding tendency or family history of bleeding disorders. She had not taken any medications except ibuprofen for her neck pain.

Stroke: Hypertensive haemorrhage – radiology video tutorial (MRI, CT)

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