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Head injury in the child
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Helen Whitwell, Christopher Milroy
If not performed clinically, a skeletal survey should be conducted. Post-mortem examination in these cases should follow a standard routine. Good-quality photography is important for both positive and pertinent negative findings. In addition to a detailed external and internal examination, extensive sampling should be conducted, including for histology, microbiology, metabolic studies, toxicology and samples for genetic testing and DNA analysis for identification.
Rules and tools
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
Older children more commonly present with fractures, but brain injury may be occult in older age groups. After dealing with any acute injuries, a full skeletal survey and a head CT should be performed. The skeletal survey consists of a standard series of radiographs to visualize the whole skeleton. The purpose of this is to detect any occult skeletal injuries and to exclude any underlying skeletal disorders that may predispose to fractures, such as osteogenesis imperfecta. The CT of the brain is recommended to exclude occult intracranial injury.
Safeguarding and protection of children and vulnerable adults
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
If physical abuse is suspected then consideration must be given to a full radiographic skeletal survey, which must subsequently be reviewed by a paediatric radiologist, and perhaps bone scintigraphy. Most jurisdictions will have standard NAI screening protocols. In addition, laboratory-based investigations may also be required and include blood count, urinalysis, liver function, amylase, calcium, phosphorus, vitamin D, screen for metabolic bone disease; coagulation studies. Endocrinological or other conditions which may affect bone strength may requires specialist referral. Table 18.1 identifies a typical skeletal survey protocol.
Abusive head trauma in India: imaging raises the curtain
Published in International Journal of Injury Control and Safety Promotion, 2022
Hima Pendharkar, Shumyla Jabeen, Nupur Pruthi, K. V. L. N Narasinga Rao, Dhaval Shukla, Nitish Kamble, Kavita V. Jangam, John Vijay Sagar Kommu, Thennarasu Kandavel, Senthil Amudhan
Spinal ligamentous injuries are also known to occur in AHT (Kadom et al., 2014; A. Kemp et al., 2014 ). Additionally, spinal SDH has also been noted in cases of AHT (Choudhary et al., 2012; 2014). In our study, spinal MRI was available in only one child (though not a dedicated study), and CT spine in two of them. As a part of the workup for AHT, ACR recommends a skeletal survey for children suspected of AHT. It is to look for associated injuries such as rib fractures and metaphyseal fractures. Though chest X-rays were available in 29/48 (60.5%) of our patients, a skeletal survey was available in only 7/48 (14.5%) cases. Rib fractures were noted in two cases. As is known, the rib fractures affect the lower thoracic ribs and the most common site of fractures is near the costovertebral junction and along the lateral margin (Shekdar, 2016). Rib fractures have very high specificity for abusive trauma and are often the key to diagnosing AHT. One of our case had a tibial shaft fracture and another child had a radial fracture.
Molecular Genetics of Cleidocranial Dysplasia
Published in Fetal and Pediatric Pathology, 2021
Jamshid Motaei, Arash Salmaninejad, Ebrahim Jamali, Imaneh Khorsand, Mohammad Ahmadvand, Sasan Shabani, Farshid Karimi, Mohammad Sadegh Nazari, Golsa Ketabchi, Fatemeh Naqipour
Cleidocranial dysplasia (CCD) is associated with severe abnormalities in bone development. The main symptoms of the disease include hypoplasia, aplasia or lack of clavicles, sloping shoulders, open fontenelles, delayed bone formation of the skull, short stature and supernumerary teeth. Afflicted people with a lack of clavicle can put their shoulders close together [4]. Dental disorders include supernumerary teeth, maxillary hypoplasia, follicular cysts in the jaw, delayed tooth eruption, delay in the development of the root of permanent teeth and delay in the absorption of the roots of deciduous teeth [5,6]. Other characteristics of CCD are hypertelorism, hypoplasia the anterior part of the face, a short nasal bridge, and narrow thorax. Patients’ intelligence is usually normal, but in some cases, deafness has been mentioned [7,8]. The presence of anomalies in the clavicle bones has been considered in several studies as a clinical finding of this syndrome. Complete recognition of clinical symptoms and differential diagnosis of CCD from other diseases with similar clinical symptoms is necessary [9]. When the clinician suspects CCD, a skeletal survey and genetic analysis should be obtained. There are several therapeutic options for CCD. To address dental problems, extensive and comprehensive dental treatments such as extraction of teeth, surgery, and orthodontics are necessary to maintain proper mastication [10].
Successful cochlear implantation in Langerhans cell histiocytosis: A rare case
Published in Cochlear Implants International, 2018
Gaurav Gupta, Avani Jain, Mohnish Grover
The diagnostic laboratory work up is particularly important in multisystem disease and should include complete blood count, coagulation profile, and liver function tests. Once a clinical diagnosis of LCH is suspected, a radiographic skeletal survey or bone scan is required for detection of bony lesions (Azouz et al., 2005). Typically, osseous involvement is represented by diffuse lytic lesions with well-defined soft-tissue margins without sclerotic margins (Bayazit et al., 2001). For temporal bone involvement, HRCT is the preferred imaging modality both to assess the extent of involvement and for monitoring disease activity and response to treatment. In this case, lytic lesions were confined to the temporal bones bilaterally and the rest of the bone scan was normal. The diagnosis of LCH is established by tissue biopsy, on the basis of pathological and immunohistochemical features. On light microscopy, a reactive infiltration of eosinophils, granulocytes, and immature Langerhans cells can be seen. The presence of Birbeck granules on electron microscopy and immunocytochemical features like CD1a antigen and S100 positivity are specific for diagnosis (Bayazit et al., 2001; Martini et al., 2000).