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Non-accidental Cerebral Injury (NACI)

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Non-accidental Cerebral Injury (NACI)

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  1. Contribution of cranial MR in combination with CT in the initial evaluation of infants and children with non-accidental cerebral injury (NACI): Correlation with presence of retinal hemorrhages (RH)Kilpadikar, Anil*, Worthington, T.**, Jones, J.G.**, Glasier, C.M***University of Arkansas for Medical Sciences**Arkansas Children’s HospitalLittle Rock, Arkansas

  2. Non-accidental Cerebral Injury (NACI) • NACI is the leading cause of death (USA) in children under 2 years of age • In children less than 1 year old, 95% of all serious head injuries and 64% of all head injuries result from maltreatment • Outcome of infants suffering NACI is considerably worse than for those of the same age who have sustained ACI

  3. Purpose Retrospectively study a large group of infants and children with documented NACI who had cranial CT, MR and ophthalmologic exam as part of an initial evaluation in order to determine: • Added utility of acute cranial MR, if any • Significance of retinal hemorrhage for prediction of severity of cerebral injury

  4. Materials and Methods • 95 consecutive infants and children age newborn to 4 years admitted from 1999-2003 with documented NACI were reviewed • 40 children in this group who had concurrent CT and MR near the time of admission were included in the study • CT exams were performed on the day of admission without contrast or sedation

  5. Materials and Methods • MR was performed within an average of 51 hrs. of the admission CT (range 0-12 days) • MR performed on a 1.5T magnet • Sequences included sagittal T1W, axial PD or FLAIR, T2W and GE images in all cases • 27/40 (68%) had DW imaging • 3/40 (7.5%) had MRA • None had spectroscopy

  6. Materials and Methods • Patient records, CT and MR reports were reviewed retrospectively with specific attention to EDH, SDH, parenchymal hemorrhage (PH), cerebral ischemic change (CIC) and retinal hemorrhage (RH) • Presence of RH was correlated with severity of cerebral injury • Maximum cerebral injury score of 3 included presence of SDH or EDH (1point), PH (1point) and CIC (1 point)

  7. Results • 30/40 (75%) had SDH • 15/40 (38%) had CIC • 9/40 (23%) had PH • 3/40 (8%) had EDH

  8. Results • In all cases CT and MR both detected EDH, SDH and PH • In patients with CIC, CT was positive in 7/15 (47%) and MR positive in 15/15 (100%) cases, which is statistically significant (p<0.05)

  9. Results • 18/40 patients with RH had a higher cerebral injury score (1.72) than 22/40 patients without RH (0.85), which is statistically significant (p<0.05)

  10. 3 year old with seizures

  11. 1 ½ year old with seizures

  12. 3 ½ year old with nausea and vomiting

  13. Unresponsive 2 year old

  14. Conclusion • Although CT and MR each detected all cases of EDH, SDH and PH, MR detected over twice as many cases of CIC as compared to CT, a statistically significant finding indicating added value for the MR examination in acute setting • Presence of RH was associated with a statistically significant increase in severity of cerebral injury

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