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PEDIATRICS Vol. 112 No. 4 October 2003, pp. 808-814

Neuroimaging of Intraparenchymal Lesions Predicts Outcome in Shaken Baby Syndrome

Christine Bonnier, MD*, Marie-Cécile Nassogne, MD, PhD*, Christine Saint-Martin, MD{ddagger}, Bettina Mesples, MD§, Hazim Kadhim, MD, PhD*,|| and Guillaume Sébire, MD, PhD*

* Service de Neurologie Pédiatrique
{ddagger} Département de Radiologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
§ Service de Pédiatrie Générale, Hopital Robert-Debré, Faculté Xavier-Bichat, Université Paris VII, Paris, France
|| Service de Neuropathologie, CHU Brugmann, ULB, Brussels, Belgium

Objective. Studies of long-term outcome on nonaccidental head injury (NAHI) in young children have shown severe neurodevelopmental sequelae in most cases. For improving the knowledge of outcome and for identifying prognostic factors, additional clinical and cerebral imaging data are needed. The aim of this study was to describe clinical and imaging features over time and to consider their value for predicting neurodevelopmental outcome.

Methods. A retrospective medical record review was conducted of 23 children with confirmed NAHI, for whom an extended follow-up of 2.5 to 13 years (mean: 6 years) was contemplated. Glasgow Coma Scale scores, severity of retinal hemorrhages, presence of skull fractures, cranial growth deceleration, and sequential neuroimaging data (computed tomography and/or magnetic resonance imaging) were compared with patterns of clinical evolution assessed by the Glasgow Outcome Scale.

Results. Clinical outcome showed that 14 (61%) children had severe disabilities, 8 (35%) had moderate disabilities, and 1 (4%) was normal. A low initial Glasgow Coma Scale score, severe retinal hemorrhages, presence of skull fracture, and cranial growth deceleration were significantly associated with poor developmental outcome. Eighteen of the 23 patients had abnormal magnetic resonance imaging scans. This examination disclosed atrophy when performed beyond 15 days of injury. Atrophy seemingly resulted from various brain lesions, namely, contusions, infarcts, and other lesions within the white matter. Presence of intraparenchymal brain lesions within the first 3 months was significantly associated with neurodevelopmental impairment. Severity of motor and cognitive dysfunctions was related to the extent of intraparenchymal lesions.

Conclusions. Early clinical and radiologic findings in NAHI are of prognostic value for neurodevelopmental outcome.

Key Words: nonaccidental head injury • traumatic brain injury • child abuse • shaken-infant syndrome • neuroimaging • outcome

Abbreviations: NAHI, nonaccidental head injury • SBS, shaken-baby syndrome • CT, computed tomography • MRI, magnetic resonance imaging • GCS, Glasgow Coma Scale • GOS, Glasgow Outcome Scale • GR, good recovery • MD, moderate disability • SD, severe disability • PVS, persistent vegetative state

Received for publication Mar 29, 2002; Accepted Feb 12, 2003.




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