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Numerous strategies for preventing abusive head trauma (AHT) have been proposed, but controlled studies failed to demonstrate their effectiveness. Digital tools may improve the effectiveness of AHT prevention strategies by reaching a large proportion of the adult population. This study aimed to describe the characteristics of videos of AHT prevention published on the internet, including their quality content, and to study their association with popularity. From a systematic appraisal performed in June 2023, we identified videos addressing the primary prevention of AHT in children younger than 2 years that were published in English or French on the internet by public organizations or mainstream associations. We analyzed the characteristics of the videos; their quality with the Global Quality Scale (GQS); and their association with an index of popularity, the Video Power Index, using multivariable quasi-Poisson modeling. We included 53 (6.6%) of the 804 videos identified. Videos were mainly published by public organizations (43/53, 81%). The median time spent on the web was 6 (IQR 3-9) years, the median length was 202 (IQR 94-333) seconds, and the median GQS score was 4 (IQR 3-4). Infants were often depicted (42/53, 79%), including while crying (35/53, 66%) and being shaken (21/53, 40%). The characterization of shaking as an abuse and its legal consequences were cited in 47% (25/53) and 4% (2/53) of videos, respectively. The main prevention strategies in the videos were to raise awareness of the noxious outcome of shaking (49/53, 93%) and convince viewers of the effectiveness of coping strategies for infants' cries (45/53, 85%). The Video Power Index was positively correlated with the GQS (r=0.38; P=.007) and was independently associated with depicting an infant being shaken (P=.03; β=1.74, 95% CI 1.06-2.85) and the use of text or headers (P=.04; β=2.15, 95% CI 1.08-4.26). AHT prevention videos had high quality but did not frequently deal with parental risk factors. The characteristics identified as being associated with the popularity of AHT prevention videos could help improve the impact of future prevention programs by enhancing their popularity.

Traumatic basal ganglia hemorrhages are among the very rare intracranial hemorrhages. In cases with bleeding in this region, high mortality and morbidity rates are encountered. This region contains many anatomically critical functional pathways. Basal ganglia hemorrhages are common in the elderly, and hypertension plays a role in its pathogenesis. Age-related comorbid factors are also relatively high in these patients. Basal ganglia hemorrhages are very rare in the pediatric age group. It can be predicted that the prognosis in this age group will be better than in the elderly. A 13-year-old man was followed up with the diagnosis of unilateral basal ganglia hemorrhage after falling from a bicycle. Right hemiparesis was present at the time of admission. Neurological findings of the patient, who was followed up with conservative treatment, completely recovered after one week. In control computed tomography examination, it was observed that the hematoma was completely resorbed. Herein, we present the clinical and radiological prognosis in a child with traumatic basal ganglia hemorrhage.

Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery.

Abusive head trauma is a severe inflicted traumatic brain injury, occurring under the age of 2 years, defined by an acute brain injury (mostly subdural or subarachnoidal haemorrhage), where no history or no compatible history with the clinical presentation is given. The mortality rate is estimated at 20-25% and outcome is extremely poor. High rates of impairments are reported in a number of domains, such as delayed psychomotor development; motor deficits (spastic hemiplegia or quadriplegia in 15–64%); epilepsy, often intractable (11–32%); microcephaly with corticosubcortical atrophy (61–100%); visual impairment (18–48%); language disorders (37–64%), and cognitive, behavioral and sleep disorders, including intellectual deficits, agitation, aggression, tantrums, attention deficits, memory, inhibition or initiation deficits (23–59%). Those combined deficits have obvious consequences on academic achievement, with high rates of special education in the long term. Factors associated with worse outcome include demographic factors (lower parental socioeconomic status), initial severe presentation (e.g., presence of a coma, seizures, extent of retinal hemorrhages, presence of an associated cranial fracture, extent of brain lesions, cerebral oedema and atrophy). Given the high risk of severe outcome, long-term comprehensive follow-up should be systematically performed to monitor development, detect any problem and implement timely adequate rehabilitation interventions, special education and/or support when necessary. Interventions should focus on children as well as families, providing help in dealing with the child’s impairment and support with psychosocial issues. Unfortunately, follow-up of children with abusive head trauma has repeatedly been reported to be challenging, with very high attrition rates.

Purpose The diagnosis of abusive head trauma (AHT) is complex and neuroimaging plays a crucial role. Our goal was to determine whether non-neuroradiologists with standard neuroradiology knowledge perform as well as neuroradiologists with experience in pediatric neuroimaging in interpreting MRI in cases of presumptive AHT (pAHT). Methods Twenty children were retrospectively evaluated. Patients had been diagnosed with pAHT (6 patients), non-abusive head trauma-NAHT (5 patients), metabolic diseases (3 patients), and benign enlargement of the subarachnoid spaces (BESS) (6 patients). The MRI was assessed blindly , i.e., no clinical history was given to the 3 non-neuroradiologists and 3 neuroradiologists from 2 different institutions. Results Blindly , neuroradiologists demonstrated higher levels of sensitivity and positive predictive value in the diagnosis of pAHT (89%) than non-neuroradiologists (50%). Neuroradiologists chose correctly pAHT as the most probable diagnosis 16 out of 18 times; in contrast, non-neuroradiologists only chose 9 out of 18 times. In our series, the foremost important misdiagnosis for pAHT was NAHT (neuroradiologists twice and non-neuroradiologists 5 times). Only victims of motor vehicle accidents were blindly misdiagnosed as pAHT. No usual household NAHT was not misdiagnosed as pAHT. Neuroradiologists correctly ruled out pAHT in all cases of metabolic diseases and BESS. Conclusion MRI in cases of suspected AHT should be evaluated by neuroradiologists with experience in pediatric neuroimaging. Neuroradiologists looked beyond the subdural hemorrhage (SDH) and were more precise in the assessment of pAHT and its differential diagnosis than non-neuroradiologists were. It seems that non-neuroradiologists mainly assess whether or not a pAHT is present depending on the presence or absence of SDH.

The devastating and for the most part irremediable consequences for an infant, his or her family, and society in cases of abusive head trauma have spurred research into ways of preventing it. In the last four or five decades, increasing interest in infant crying and its clinical manifestation of colic has led to a reconceptualization of crying in early infancy, such that most of the characteristics of colic can be understood as manifestations of the crying typical of normal infants. This includes an early increase and then decrease in the amount of crying, the unexpected and unpredictable appearance of prolonged crying bouts, and the presence of inconsolable crying that occurs in the early months of life. When these concepts are merged with anecdotal clinical experiences, perpetrator confessions and epidemiological evidence of abusive head trauma, it is clear that these crying characteristics — and caregiver responses — are the predominant, and potentially modifiable, risk factors for abusive head trauma. This unfortunate but understandable relationship between early crying, shaking and abuse has opened windows of opportunity for primary, universal prevention efforts that are appropriate for — and support — all parents and may be able to prevent at least some of these tragic cases.

BACKGROUND: Head trauma is a leading cause of death and disability. While standard treatment protocols exist for severe head trauma, no clear follow-up standards are available for mild head trauma with positive imaging findings in infants and newborns. Although routine follow-up brain computed tomography (CT) imaging is not recommended for children with moderate and mild head trauma, the necessity for follow-up imaging in infants and newborns remains uncertain. METHODS: Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package. RESULTS: Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on followup CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay. CONCLUSION: Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings. Keywords: Brain computed tomography (CT) imaging; follow-up CT; head trauma; infants; mild head trauma; newborns; radiation exposure. AMAC: Kafa travmasi, olum ve sakatligin onde gelen nedenleir. Agir kafa travmasi icin standart tedavi protokolleri mevcutken, bebeklerde ve yenidoganlarda pozitif goruntuleme bulgulari olan hafif kafa travmalari icin net takip standartlari bulunmamaktadir. Orta ve hafif kafa travmasi olan cocuklarda kontrol beyin BT goruntulemesi rutin olarak onerilmezken, bebekler ve yenidoganlarda kontrol goruntuleme ihtiyaci belirsizligini korumaktadir. GEREC VE YONTEM: Calismamiz retrospektif, gozlemsel ve tanimlayici bir calismadir. Ankara Etlik Sehir Hastanesi Etik Kurulu onayi ile acil servise izole kafa travmasi ile basvuran 1 yas alti hastalar incelendi. Dahil edilme kriterleri arasinda acil servise basvuru, birden fazla beyin BT cekilmesi ve hafif kafa travmasi (GKS >13) yer aldi. Eksik takip verileri veya coklu travmasi olan hastalar haric tutuldu. Yas, cinsiyet, travma mekanizmasi, ilk ve kontrol beyin BT bulgulari, hastaneye yatis ve cerrahi islemler kaydedildi ve SPSS istatistik paketi kullanilarak analiz edildi. BULGULAR: Tarama sonucu bulunan 238 hastadan 154'u calismaya dahil edildi. Bu 154 hastanin %66.9'u erkekti ve yas ortalamasi 5.99 aydi. En sik basvuru semptomu %79.2 ile travma bolgesinde sislikti. En sik gorulen travma mekanizmasi %85.1 ile dusme (<90 cm) idi. Kontrol BT'de patolojik ilerleme hastalarin %5.2'sinde gozlendi ve yalnizca %1.9'unda cerrahi tedavi gerekti. Hastalarin %34.4'u hastaneye yatirildi. Beyin parankimal patolojisi olan hastalar, kontrol BT'de daha yuksek oranda patolojik ilerleme ve daha uzun hastanede kalis gosterdi. SONUC: Hafif kafa travmali bebeklerde kontrol beyin BT taramalari, beyin parankimal patolojisi olan vakalar disinda hasta sonuclarini degistirmemektedir. Calisma verileri izole kafatasi kiriklarinda tekrar goruntulemenin faydasi olmadigini gosterdi. Goruntuleme artefaktlari, taramalarin tekrarlanmasini gerektirmis ve bu da radyasyona maruz kalmanin artmasina katkida bulunmustur. Gereksiz tekrarlanan goruntuleme, radyasyona maruz kalmayi ve maliyetleri artirmaktadir. Hastalarin kucuk bir yuzdesinde intrakraniyal patolojinin ilerlemesi gozlendi, bu da kontrol goruntulemenin yalnizca beyin parankimal hasari varliginda yapilmasini hakli gostermektedir. Bu bulgulari dogrulamak icin daha buyuk orneklem buyuklugune sahip prospektif calismalara ihtiyac vardir. Anahtar sozcukler: Bebekler; beyin BT goruntulemesi; hafif kafa travmasi; kafa travmasi; kontrol BT; radyasyon maruziyeti; yenidoganlar.

Traumatic brain injury (TBI) results in a number of impairments, often including visual symptoms. In some cases, visual impairments after head trauma are mediated by traumatic injury to the optic nerve, termed traumatic optic neuropathy (TON), which has few effective options for treatment. Using a murine closed-head weight-drop model of head trauma, we previously reported in adult mice that there is relatively selective injury to the optic tract and thalamic/brainstem projections of the visual system. In the current study, we performed blunt head trauma on adolescent C57BL/6 mice and investigated visual impairment in the primary visual system, now including the retina and using behavioral and histologic methods at new time points. After injury, mice displayed evidence of decreased optomotor responses illustrated by decreased optokinetic nystagmus. There did not appear to be a significant change in circadian locomotor behavior patterns, although there was an overall decrease in locomotor behavior in mice with head injury. There was evidence of axonal degeneration of optic nerve fibers with associated retinal ganglion cell death. There was also evidence of astrogliosis and microgliosis in major central targets of optic nerve projections. Further, there was elevated expression of endoplasmic reticulum (ER) stress markers in retinas of injured mice. Visual impairment, histologic markers of gliosis and neurodegeneration, and elevated ER stress marker expression persisted for at least 30 days after injury. The current results extend our previous findings in adult mice into adolescent mice, provide direct evidence of retinal ganglion cell injury after head trauma and suggest that axonal degeneration is associated with elevated ER stress in this model of TON.

This review presents an up-to-date overview of ocular injuries resulting from child abuse, with a spotlight on abusive head trauma. Retinal hemorrhage is a principle finding of inflicted head trauma. The specific pattern of hemorrhages holds valuable diagnostic information, which can help to guide multidisciplinary assessments of the likelihood of abuse. Indirect ophthalmoscopy through dilated pupils by an ophthalmologist is necessary for adequate examination and documentation of retinal findings. Initial pediatrician evaluation of the eye and indications for ophthalmological consultation are reviewed. Focus is then placed upon understanding retinal hemorrhage patterns, their diagnostic significance and likely pathophysiological mechanisms. The differential diagnosis of retinal hemorrhage in young children is discussed, highlighting key distinctions among retinal hemorrhage patterns, severity and frequencies, as well as other ocular findings. The most common cause of retinal hemorrhage in an infant is trauma, and most other causes can be identified by considering the hemorrhage pattern, ocular or systemic signs and the results of laboratory and imaging tests, when indicated.