Is your case really child abuse?

Abusive Head Trauma or Pediatric Stroke?

Abusive Head Trauma is a challenging diagnosis that should be evaluated by a medical professional with the collaboration of other disciplines. The presentation of a lethargic child, with mental status changes, vomiting, diarrhea, irritability, seizure activity, sleepiness and/or drowsiness does not always point to child abuse. Individual clinical presentations/diagnoses should not immediately lead the clinical evaluator to the diagnosis of Abuse Head Trauma or child abuse.  

Cerebrovascular ischemia, also known as a stroke, is caused by an interruption of the normal blood flow to the brain caused by either a blockage or a rupture of the blood vessels. There are only two causes of stroke: blockage and bleeding. In a stroke caused by blockage, diagnostic radiology results can show signs of thrombosis (blood clot), which can indicate an ischemic stroke. This means a blood clot is blocking the blood flow to brain resulting in a stroke. In a bleeding stroke, this occurs when a blood vessel in the brain ruptures and bleeds into the brain itself. 

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Pediatric stroke is not a common occurrence and can lead to significant morbidity and mortality. Roughly 10 to 25% of children with a stroke will die, 25% of children will experience recurrence and up to 66% will have persistent neurological defects or develop subsequent seizure disorders, learning or developmental problems (Tsze, 2011). Children can present with a change in mental status, headache, seizure activity, vomiting, somnolence and fever.

Some of the causes for pediatric stroke include, but are not limited to:

  1. Congenital issues
  2. Volume depletion or systemic hypotension
  3. Infection such as meningitis
  4. Drugs
  5. Cardiac issues
  6. Leukemia
  7. Bleeding diathesis
  8. Down Syndrome
  9. Diabetes

(Titomanlio, 2013)


Titomanlio, L. e. (2013, February). Pediatric Ischemic Stroke: Acute Management and Areas of Research . Retrieved from Journal of Pediatrics:

Tsze, D. a. (2011, December 27). Pediatric Stroke: A Review. Retrieved from National Institutes of Health: