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Orru' E, Huisman TAGM, Izbudak I. Prevalence, Patterns, and Clinical Relevance of Hypoxic-Ischemic Injuries in Children Exposed to Abusive Head Trauma. J Neuroimaging. 2018;28(6):608-614doi: 10.1111/jon.12555.
Orru', E., Huisman, T. A. G. M., & Izbudak, I. (2018). Prevalence, Patterns, and Clinical Relevance of Hypoxic-Ischemic Injuries in Children Exposed to Abusive Head Trauma. Journal of neuroimaging : official journal of the American Society of Neuroimaging, 28(6), 608-614. https://doi.org/10.1111/jon.12555
Orru', Emanuele, et al. "Prevalence, Patterns, and Clinical Relevance of Hypoxic-Ischemic Injuries in Children Exposed to Abusive Head Trauma." Journal of neuroimaging : official journal of the American Society of Neuroimaging vol. 28,6 (2018): 608-614. doi: https://doi.org/10.1111/jon.12555
Orru' E, Huisman TAGM, Izbudak I. Prevalence, Patterns, and Clinical Relevance of Hypoxic-Ischemic Injuries in Children Exposed to Abusive Head Trauma. J Neuroimaging. 2018 Nov;28(6):608-614. doi: 10.1111/jon.12555. Epub 2018 Aug 19. PMID: 30125430.
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J Neuroimaging. 2018 Nov;28(6):608-614. doi: 10.1111/jon.12555. Epub 2018 Aug 19.

Prevalence, Patterns, and Clinical Relevance of Hypoxic-Ischemic Injuries in Children Exposed to Abusive Head Trauma.

Journal of neuroimaging : official journal of the American Society of Neuroimaging

Emanuele Orru', Thierry A G M Huisman, Izlem Izbudak

Affiliations

  1. Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD.
  2. Division of Pediatric Radiology and Pediatric Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD.

PMID: 30125430 DOI: 10.1111/jon.12555

Abstract

BACKGROUND AND PURPOSE: Hypoxic-ischemic injuries (HIIs) are a scarcely investigated but important cause of morbidity and mortality in children who suffered abusive head trauma (AHT). The purpose of this study is to determine: (a) prevalence, types, and clinical relevance of cytotoxic edema compatible with HII in nonpenetrating AHT, (b) their relationship to other classic neuroimaging findings of AHT, and (c) their correlation with clinical outcomes.

METHODS: Diffusion-weighted imaging sequences of magnetic resonance imagings performed on children under 5 years diagnosed with AHT were reviewed to detect the most common patterns of acute parenchymal damage. Patterns of cytotoxic edema were described, and HII-compatible ones divided in subtypes. Correlation between HII, fractures, and subdural hemorrhages (SDHs) and with clinical outcomes was determined using imaging and available follow-up data.

RESULTS: Out of 57 patients, 36.8% showed lesions compatible with HII. A predominantly asymmetric cortical distribution was observed in 66.7% of cases, while 33.3% had diffused both cortical and deep gray/white matter distribution injury. Traumatic axonal injuries and focal contusions were less common. There was no significant correlation between the presence of SDH (P = .6) or skull fractures (P = .53) and HII. HII was the most severe form of parenchymal damage in terms of in-hospital mortality and morbidity at follow-up.

CONCLUSIONS: HII is the most common type of parenchymal damage in children victim of AHT, being present in 1/3 of patients with this condition, and correlates with more severe outcomes. Its presence is independent from other classic traumatic findings such as SDH and fractures.

© 2018 by the American Society of Neuroimaging.

Keywords: Hypoxia-ischemia; abusive; hypoxic-ischemic; pediatric; trauma

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