A verified period of normal neurologic status in a young victim of abusive head trauma
Abusive head trauma (AHT) is the leading cause of child physical abuse fatalities, and survivors frequently face life-long consequences. Victims of AHT are typically infants, and many are subjected to repeat AHT if not accurately identified and protected. Identifying the timing of AHT is often a medical-forensic process, and investigative personnel use the determination of timing of AHT to guide safety decisions for the child victim. If the medical-forensic timing of AHT is incorrect, a child could be inappropriately placed and/or an innocent caregiver could be subject to prosecution. Victims of AHT who suffer severe/permanent injury are felt to demonstrate symptoms immediately after the trauma, and AHT victims with milder injury are thought to generally have persistent or recurrent clinical signs shortly after the trauma. Periods of normal neurologic appearance, in which a victim of AHT is completely asymptomatic for an extended time after the trauma, are felt to be rare and have not been well characterized in the literature. This case involves a 2-month-old infant victim of AHT who presented to medical care with mild neurologic symptoms that resolved without intervention from medical personnel. While hospitalized, the infant had an asymptomatic period of approximately 38 hours prior to more severe neurologic decompensation, then later returned to neurologic baseline. This case highlights the challenges in accurately timing AHT in very young victims who return to neurologic baseline by characterizing a verifiable prolonged period of normal neurologic appearance and function after AHT.
Journal of Forensic and Legal Medicine
Abusive head trauma; Injury timing; Child physical abuse; Child protection
Romig R, Doswell A, Horton D, Kachelski C, Anderst J. A verified period of normal neurologic status in a young victim of abusive head trauma. Journal of Forensic and Legal Medicine. 2020;74:102024. doi:10.1016/j.jflm.2020.102024