ArticleInternational journal of legal medicine2015
Encephalopathy and death in infants with abusive head trauma is due to hypoxic-ischemic injury following local brain trauma to vital brainstem centers.
Article in International journal of legal medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 48 citations in OpenAlex.
- Can Hemorrhagic Stroke Genetics Help Forensic Diagnosis in Pediatric Age (<5 Years Old)?Genes · 2024Pooled it
- Brain lesions in pediatric abusive head trauma: prevalence, pathophysiology, patterns, and a classification system.European radiology · 2026Article
- Forensic neuropathology: 2026 update.Free neuropathology · 2026Review
- Spinal cord injury in abusive and accidental head injury in children, a neuropathological investigation.International journal of legal medicine · 2025Article
- Neuroradiological findings in children with subdural hematoma and suspected abusive head trauma.Annals of the Child Neurology Society · 2023Article
- Diagnosis of Abusive Head Trauma : Neurosurgical Perspective.Journal of Korean Neurosurgical Society · 2022Article
- Parenchymal Insults in Abuse-A Potential Key to Diagnosis.Diagnostics (Basel, Switzerland) · 2022Review
- A National Analysis of Ophthalmic Features and Mortality in Abusive Head Trauma.JAMA ophthalmology · 2022Article
- Parenchymal brain injuries in abusive head trauma.Pediatric radiology · 2021Review
- Shaken Baby Syndrome: Magnetic Resonance Imaging Features in Abusive Head Trauma.Brain sciences · 2021Review
- Patterns of Osteopontin Expression in Abusive Head Trauma Compared with Other Causes of Pediatric Traumatic Brain Injury.The Journal of pediatrics · 2020Article
- Cerebellar heterotopia of infancy in sudden infant death syndrome: an observational neuropathological study of four cases.International journal of legal medicine · 2020Observational
- Altered plasma-type gelsolin and amyloid-β in neonates with hypoxic-ischaemic encephalopathy under therapeutic hypothermia.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2019Article
- Various Cranial and Orbital Imaging Findings in Pediatric Abusive and Non-abusive Head trauma, and Relation to Outcomes.Clinical neuroradiology · 2019Article
- Abusive Head Trauma and Mortality-An Analysis From an International Comparative Effectiveness Study of Children With Severe Traumatic Brain Injury.Critical care medicine · 2017Observational
- A Conceptual Overview of Axonopathy in Infants and Children with Allegedly Inflicted Head Trauma.Academic forensic pathology · 2016Review
Corrections and comments
- Erratum issued
Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInfants with abusive head trauma (AHT) have diffuse brain damage with potentially fatal brain swelling. The pathogenesis of the brain damage remains unclear. We hypothesize that brain damage in AHT is due to hypoxic-ischemic injury with hypoxic-ischemic encephalopathy (HIE) rather than primary traumatic brain injury (TBI) with traumatic diffuse axonal injury (tDAI).
methodsWe studied brain tissue of AHT victims. Primary outcome measure was the presence of primary traumatic versus hypoxic-ischemic brain injury. The diagnosis of tDAI followed a standardized semiquantitative diagnostic approach yielding a 4-tiered grading scheme (definite, possible, improbable, and none). In addition, results of quantitative immunohistochemical analysis in a subgroup of AHT victims with instant death were compared with matched SIDS controls.
resultsIn our cohort of 50 AHT victims, none had definite tDAI (no tDAI in 30, tDAI possible in 2, and tDAI improbable in 18). Instead, all AHT victims showed morphological findings indicative of HIE. Furthermore, the subgroup with instant death showed significantly higher counts of damaged axons with accumulation of amyloid precursor protein (APP) in the brainstem adjacent to the central pattern generator of respiratory activity (CPG) (odds ratio adjusted for age, sex, brain weight, and APP-count in other regions = 3.1; 95 % confidence interval = 1.2 to 7.7; p = 0.015).
conclusionsAHT victims in our cohort do not have diffuse TBI or tDAI. Instead, our findings indicate that the encephalopathy in AHT is the due to hypoxic-ischemic injury probably as the result of respiratory arrest due to local damage to parts of the CPG in the brainstem.
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