Clinical analysis of non-accidental head injury in infants

Abstract

We present the clinical features, radiological findings and outcome of infants with non-accidental head injury presenting to our department between 2001 and 2003. There were 26 male and 13 female infants, aged between 7 days and 5 months. Presenting symptoms included seizures, vomiting, bulging fontanel, decreased level of consciousness, focal neurological signs, anemia and respiratory distress. We classified the patients into three groups: mild head injury (8 patients), moderate head injury (11 patients) and severe head injury (20 patients). Detailed history taking and thorough physical examination, did not reveal obvious injury or abuse (by the parents), other external visible injury or significant incidence of retinal bleeding. CT scan showed intracranial hemorrhage in all patients, most commonly including acute or acute on chronic subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) in the parafalcine and tentorial regions and over the brain convexity, associated with focal or diffuse hypodensity of the parenchyma. Intracranial lesions were mostly bilateral (80%). These patients generally had a poor outcome; 31% died, 23% had a good outcome, and the remainder recovered with neurological impairment of varying types and degrees. After comprehensive assessment, we concluded that all the cases in our series were "non-accidental" head injuries. However, the absence of retinal bleeding, visible external injury and recognised abuse in our series differed from reports by other investigators. In our opinion these features are not absolute requirements in diagnosing "non-accidental" injury and detailed history taking, thorough clinical examination and radiological studies were the key indicators of the diagnosis.