{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T09:30:20Z","timestamp":1793179820914,"version":"4.5.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["WI 5034\/2-1"],"award-info":[{"award-number":["WI 5034\/2-1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n A deeper understanding of extensive brain lesions (EBL) in pediatric abusive head trauma (AHT) could possibly help differentiate AHT from other forms of trauma. Therefore, the aims of the study were (i) to investigate the prevalence and features of AHT-associated EBL in neuroimaging and (ii) to develop a useful classification system.<\/jats:p>\n <\/jats:sec>\n \n Materials and methods<\/jats:title>\n This retrospective multicenter study analyzed cranial CT and\/or MRI of medico-legally well-documented AHT cases diagnosed with \u201cshaken baby syndrome\u201d from a 10-year study period with respect to lesions in cerebrum, cerebellum, and brain stem. For the development of a classification system, EBLs were grouped into distinct lesion patterns based on laterality, symmetry, distribution, and shape.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 61 AHT cases were included. Comparison between \u201cconfession cases\u201d (\n n<\/jats:italic>\n \u2009=\u200915) and \u201cnon-confession cases\u201d (\n n<\/jats:italic>\n \u2009=\u200946) did not show any statistically significant difference regarding all parameters analysed. EBL were found in ~\u20091\/3 of the cases (\n n<\/jats:italic>\n \u2009=\u200920). Brain stem lesions were only rarely observed (\n n<\/jats:italic>\n \u2009=\u20092). Nine different and partly new patterns of EBL occurring in AHT by shaking are described. Pattern analysis revealed that most lesions can be caused by hypoxic-ischemic injury, but evidence is provided that additional pathomechanisms, such as hypoglycemia and the \u201csecond impact syndrome\u201d, may be causative or a component.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Brain lesions in AHT by shaking form typical patterns that can be categorized. Considering the rare observation of brain stem lesions, the widespread hypothesis of primary brain stem lesions leading to initial respiratory insufficiency in AHT by shaking should be questioned.<\/jats:p>\n <\/jats:sec>\n \n Key Points<\/jats:title>\n \n \n Question<\/jats:italic>\n <\/jats:bold>\n Current data on extensive brain lesion patterns in abusive head trauma are insufficient with regard to nomenclature, pathophysiology, and a classification system.<\/jats:italic>\n <\/jats:p>\n \n \n Findings<\/jats:italic>\n <\/jats:bold>\n Nine different patterns of extensive brain lesions were found in abusive head trauma by shaking, which indicates different pathomechanisms and may help diagnose child abuse.<\/jats:italic>\n <\/jats:p>\n \n \n Clinical relevance<\/jats:italic>\n <\/jats:bold>\n Consideration of the identified lesion patterns provides new insights into underlying pathomechanisms and supports the clinical diagnosis of abusive head trauma.<\/jats:italic>\n <\/jats:p>\n <\/jats:sec>\n \n Graphical Abstract<\/jats:title>\n <\/jats:sec>","DOI":"10.1007\/s00330-025-11895-5","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T12:34:13Z","timestamp":1755174853000},"page":"1229-1239","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Brain lesions in pediatric abusive head trauma: prevalence, pathophysiology, patterns, and a classification system"],"prefix":"10.1007","volume":"36","author":[{"given":"Maria","family":"Hahnemann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Karger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Pfeiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Joachim","family":"Mentzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Radbruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1344-7488","authenticated-orcid":false,"given":"Daniel","family":"Wittschieber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"key":"11895_CR1","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1542\/peds.2009-0408","volume":"123","author":"CW Christian","year":"2009","unstructured":"Christian CW, Block R, Committee on Child Abuse and Neglect, American Academy of Pediatrics (2009) Abusive head trauma in infants and children. 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In addition, the study has been approved and supported by the Ministry of Justice of the Federal State of North Rhine-Westphalia and the Attorney General\u2019s Office (file number: 1410 E-II. 75\/17).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Some study subjects or cohorts have been previously reported in \u201cAbusive head trauma in court: a multi-center study on criminal proceedings in Germany\u201d by K. Feld et al (2021;\n \n ), \u201cFractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study\u201d by K. Feld et al (2022;\n \n ), \u201cViolence against children by means of shaken baby syndrome: Criminal-sociological studies on the socio-economic state of suspects who made a confession\u201c by M.L. Hahnemann et al (2022;\n \n ), \u201cCharacterization of subdural collections in initial neuroimaging of abusive head trauma: Implications for forensic age diagnostics and clinical decision-making\u201d by M.L. Hahnemann et al (2023;\n \n ), \"Neurological symptoms in pediatric abusive head trauma: multi-center data for clinical forensic medicine\" by K. Feld et al. (2024;\n \n ) and \u201cTemporal development of subdural collections in infants with confessed abusive head trauma: a forensic neuroimaging study\u201d by M. Hahnemann et al (2025;\n \n ).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}