Section of Pediatric Neurosurgery, Fernandes Figueira Institute - Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro, RJ, Brazil.
Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil.
Childs Nerv Syst. 2022 Dec;38(12):2311-2315. doi: 10.1007/s00381-023-05845-z. Epub 2023 Jan 24.
Abusive head trauma (AHT) is the most serious injury inflicted to the nervous system of neonate an infant with a high incidence of disabilities. The authors present two cases in which the initial manifestations and neurologic status were misinterpreted and stress that clinical presentation and imaging can be variable and confuse the examiner.
Subdural hemorrhage (SDH) in this age group raises high suspicion of non-accidental trauma but have been reported in other situations such as several bleeding disorders. Although rare, hematological diseases should be considered when other data of maltreatment are lacking.
Differential diagnosis is important to avoid underdiagnosing AHT and to prevent morbidity if a pre-existing hematological disease is misdiagnosed.
虐待性头部外伤（AHT）是对新生儿和婴儿神经系统造成的最严重损伤，其发病率很高，且常伴有残疾。作者介绍了两个病例，在这两个病例中，初始表现和神经状态被误诊，并强调了临床表现和影像学检查可能存在多样性，这会使检查者感到困惑。
在这个年龄段，硬膜下血肿（SDH）高度提示非意外伤害，但也有报道称在其他情况下，如几种出血性疾病中也会出现这种情况。尽管罕见，但如果缺乏虐待的其他数据，则应考虑血液系统疾病。
鉴别诊断很重要，以避免漏诊 AHT，如果误诊了先前存在的血液系统疾病，还可以防止发病。
