Abusive head and spinal trauma: Presentation, indications for imaging and imaging strategies

This chapter reviews the most common clinical presentations of abusive head trauma (AHT) and associated indications for imaging. The presentation of AHT is highly variable, and may include a history of accidental trauma, acute neurologic or constitutional symptoms, sentinel non-central nervous system (CNS) injuries, macrocephaly or chronic neurologic dysfunction or asymptomatic high-risk contacts of a child abuse victim. The indications for screening neuroimaging depend on clinical presentation and level of concern. Some patients warrant evaluation based on acute neurological presentation. In others the clinical history, physical examination, laboratory and non-CNS radiologic findings indicate the need for screening. This chapter reviews the available evidence and outlines an approach to screening neuroimaging followed by diagnostic evaluation. Cranial ultrasound, CT or MRI are used depending on presentation and clinical setting. If screening neuroimaging is suspicious for AHT then full diagnostic neuroimaging evaluation with brain and often spine MRI is essential. Strengths and limitations of the modalities used are discussed.