Findings on Diffusion-Weighted MRI May Point to Shaken-Baby Syndrome

NEW YORK (Reuters Health) Feb 25 – Conducting diffusion-weighted MRI scans immediately upon admission for suspicion of shaken-baby syndrome (SBS) adds crucial information needed for diagnosis, report investigators, from the Emory University School of Medicine in Atlanta.
Dr. Val rie Biousse and colleagues retrospectively reviewed records of 26 children aged 6 weeks to 24 months in whom suspected or confirmed SBS was diagnosed. As reported in the American Journal of Ophthalmology for February, all subjects had a subdural hematoma, 10 had occult bone fractures, and 18 had retinal hemorrhages. SBS was confirmed in one case that exhibited a normal fundus and 17 that had retinal hemorrhages.

In the 18 patients with confirmed SBS, abnormal diffusion-weighted MRI suggested cerebral ischemia, while such imaging was normal in the eight patients in whom SBS could not be confirmed. The cerebral infarctions were often not evident or were underestimated on conventional computed tomography and MRI.

"The demonstration of associated cerebral ischemia acutely may be the key to the diagnosis of SBS, making diffusion-weighted MRI an extremely useful technique," the investigators suggest.

Other advantages of this imaging technique, the authors add, include its ability to differentiate ischemia from traumatic axonal injury, which could influence management. Dr. Biousse and her associates recommend that treatments designed to protect the brain from the effects of acute ischemia, when its presence is demonstrated, would be more critical than treatment for traumatic axonal injury and posttraumatic cerebral edema.

Am J Ophthalmol 2002;133:249-255.

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