A modern restatement of the definition of SBS is that it represents a form of physical NAI to infants characterized by "the triad" of (1) subdural hemorrhage (SDH), (2) retinal hemorrhage (RH), and (3) encephalopathy (ie, diffuse axonal injury [DAI]) occurring in the context of inappropriate or inconsistent history and commonly accompanied by other apparently inflicted injuries
These are the "mimics" of NAI that often present as acute life-threatening events (ALTE). This includes hypoxia-ischemia (eg, apnea, choking, respiratory or cardiac arrest), ischemic injury (arterial vs venous occlusive disease), seizures, infectious or postinfectious conditions, coagulopathy, fluid-electrolyte derangement, and metabolic or connective tissue disorders.
Many cases seem multifactorial and involve a combination or sequence of contributing events or conditions.[4,5,10] For example, an infant is dropped and experiences a head impact with delayed seizure, choking spell, or apnea, and then undergoes a series of prolonged or difficult resuscitations, including problematic airway intubation with subsequent hypoxic-ischemic brain injury. Another example is a young child with ongoing infectious illness, fluid-electrolyte imbalance, and coagulopathy, and then experiences seizures, respiratory arrest, and resuscitation with hypoxic-ischemic injury.
Often, the imaging findings are neither characteristic of nor specific for NAI. Because of the widely acknowledged controversy in NAI, the radiologist involved in such cases must be thoroughly familiar with the imaging, clinical, surgical, pathological, biomechanical, and forensic literature from all perspectives and with the principles of evidence-based medicine (EBM).[4,5,10] Children with suspected NAI versus AI must not only receive protective evaluation but also require a timely and complete clinical and imaging workup to evaluate the pattern of injury and timing issues and to consider the mimics of abuse.[4,5,10] All imaging findings must be correlated with clinical findings (including current and past medical record) and with laboratory and pathological findings (eg, surgical, autopsy). The medical and imaging evidence, particularly when there is only CNS injury, cannot reliably diagnose intentional injury. Only the child protection investigation may provide the basis for inflicted injury in the context of supportive medical, imaging, biomechanical, or pathological findings.[4,5,10]
SOURCE:CUT ND PASTED FROM MYPACS.COM,NEURORADILOGY CASE NOTES
These are the "mimics" of NAI that often present as acute life-threatening events (ALTE). This includes hypoxia-ischemia (eg, apnea, choking, respiratory or cardiac arrest), ischemic injury (arterial vs venous occlusive disease), seizures, infectious or postinfectious conditions, coagulopathy, fluid-electrolyte derangement, and metabolic or connective tissue disorders.
Many cases seem multifactorial and involve a combination or sequence of contributing events or conditions.[4,5,10] For example, an infant is dropped and experiences a head impact with delayed seizure, choking spell, or apnea, and then undergoes a series of prolonged or difficult resuscitations, including problematic airway intubation with subsequent hypoxic-ischemic brain injury. Another example is a young child with ongoing infectious illness, fluid-electrolyte imbalance, and coagulopathy, and then experiences seizures, respiratory arrest, and resuscitation with hypoxic-ischemic injury.
Often, the imaging findings are neither characteristic of nor specific for NAI. Because of the widely acknowledged controversy in NAI, the radiologist involved in such cases must be thoroughly familiar with the imaging, clinical, surgical, pathological, biomechanical, and forensic literature from all perspectives and with the principles of evidence-based medicine (EBM).[4,5,10] Children with suspected NAI versus AI must not only receive protective evaluation but also require a timely and complete clinical and imaging workup to evaluate the pattern of injury and timing issues and to consider the mimics of abuse.[4,5,10] All imaging findings must be correlated with clinical findings (including current and past medical record) and with laboratory and pathological findings (eg, surgical, autopsy). The medical and imaging evidence, particularly when there is only CNS injury, cannot reliably diagnose intentional injury. Only the child protection investigation may provide the basis for inflicted injury in the context of supportive medical, imaging, biomechanical, or pathological findings.[4,5,10]
SOURCE:CUT ND PASTED FROM MYPACS.COM,NEURORADILOGY CASE NOTES
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