title: Neuroimaging of intraparenchymal lesions predicts outcome in shaken baby syndrome.
abstract: OBJECTIVE
  Studies of long-term outcome on nonaccidental head injury (NAHI) in young children have shown severe neurodevelopmental sequelae in most cases. For improving the knowledge of outcome and for identifying prognostic factors, additional clinical and cerebral imaging data are needed. The aim of this study was to describe clinical and imaging features over time and to consider their value for predicting neurodevelopmental outcome.
  
  
  METHODS
  A retrospective medical record review was conducted of 23 children with confirmed NAHI, for whom an extended follow-up of 2.5 to 13 years (mean: 6 years) was contemplated. Glasgow Coma Scale scores, severity of retinal hemorrhages, presence of skull fractures, cranial growth deceleration, and sequential neuroimaging data (computed tomography and/or magnetic resonance imaging) were compared with patterns of clinical evolution assessed by the Glasgow Outcome Scale.
  
  
  RESULTS
  Clinical outcome showed that 14 (61%) children had severe disabilities, 8 (35%) had moderate disabilities, and 1 (4%) was normal. A low initial Glasgow Coma Scale score, severe retinal hemorrhages, presence of skull fracture, and cranial growth deceleration were significantly associated with poor developmental outcome. Eighteen of the 23 patients had abnormal magnetic resonance imaging scans. This examination disclosed atrophy when performed beyond 15 days of injury. Atrophy seemingly resulted from various brain lesions, namely, contusions, infarcts, and other lesions within the white matter. Presence of intraparenchymal brain lesions within the first 3 months was significantly associated with neurodevelopmental impairment. Severity of motor and cognitive dysfunctions was related to the extent of intraparenchymal lesions.
  
  
  CONCLUSIONS
  Early clinical and radiologic findings in NAHI are of prognostic value for neurodevelopmental outcome.
authors.affiliation: Service de Neurologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. Bonnier@nepe.ucl.ac.be
authors.forename: Christine
authors.initials: C
authors.lastname: Bonnier
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Nassogne
authors.forename: Christine
authors.initials: C
authors.lastname: Saint-Martin
authors.forename: Bettina
authors.initials: B
authors.lastname: Mesples
authors.forename: Hazim
authors.initials: H
authors.lastname: Kadhim
authors.forename: Guillaume
authors.initials: G
authors.lastname: Sébire
mesh_terms: D001284:Atrophy; D001530:Belgium / Q000453:epidemiology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001925:Brain Damage, Chronic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D038642:Shaken Baby Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D012887:Skull Fractures / Q000453:epidemiology / Q000209:etiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome