Which conditions are included in the differential diagnoses of physical child abuse when CNS injuries are present?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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CNS injuries

The differential diagnoses for the altered mental status findings observed in CNS injuries include various serious disorders such as meningitis, neurologic conditions that have seizures as a component, and ingestions that may simulate the serious clinical features of CNS injury.

A child with CNS injury often is seriously ill, presenting in a life-threatening condition with seizures and respiratory arrest. For serious life-threatening injury, no data support the existence of a lucid period between the time of injury and the onset of symptoms; rather, for acute subdural hematoma with severe neurologic sequela, clinical deterioration would be expected immediately around the time of injury. Traumatic acute subdural hematomas, especially those that lead to the death of child, do not occur in a subclinical or insidious manner in an otherwise healthy infant.

Abusive head trauma (AHT)

In considering the differential diagnoses for the findings in AHT, the differential diagnosis subdural hematoma and retinal hemorrhages needs to be considered. For subdural hematoma, the differential diagnoses include accidental trauma, coagulation disorders, vascular malformations, the rare amino acid inborn error of metabolism glutaric aciduria type I (associated with acute encephalopathy and chronic subdural hematoma), and the folk-healing practice caida di mollera, in which a child with a sunken fontanel is inverted, held upside down by the ankles, and shaken.

Retinal hemorrhages

For retinal hemorrhages, the differential diagnoses include vasculitis, vascular obstruction, and toxic febrile states associated with serious infection. Again, in working through a differential diagnoses, the workup should reveal history and physical examination findings supportive of such a diagnosis over physical abuse.

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