 This is a second example of a patient who was suspected of sustaining child abuse, non-accidental trauma. On this case, one can see the presence of blood prox along the right lateral temporal lobe, likely representing a subdural hematoma by virtue of the fact that it's crossing suture lines and coming along the middle cranial fossa floor. There also is blood prox along the intrahemispheric fissure. So intrahemispheric subdural hematomas in children is a marker for potential child abuse. You see that there's a collection overlying the right parietal region as well. One of the findings that was noted on this case also was the fact that there seemed to be some element of a loss of the gray-white differentiation. It doesn't seem like we can sort of separate good quality gray matter from the white matter, and this had sort of a bland appearance to it. For that reason, the patient was recommended for MRI scanning. This is the MRI scan of the patient, which was performed on the same day. Once again, we can see, as in the previous case, high signal intensity on T2-wayed scanning, which is extending into the occipital region and parietal region by rarity and fairly symmetric. The diffusion-wayed scan is even more striking in that we see cortical high signal intensity on the diffusion-wayed scan in the medial aspect of the occipital lobes as well as extending to the temporal lobes, and you also see bright signal intensity bilaterally in the thalamide. This is symmetrical. This is high signal intensity also demonstrated in the frontal gray matter extending to the parietal lobe on the right side as well as to a lesser extent on the left side. This is confirmed on the ADC maps. The patient underwent MRI scanning of the spine to look for any additional areas of trauma, which was not present. The abnormality that was demonstrated here on the T2-wayed scan as well as the diffusion-wayed scan and confirmed on the ADC maps also represents another example of the diffuse injury to the brain that can occur with shaken baby syndrome. That is, there is diffuse shearing of gray-white fiber tracks such that there is an outpouring of neurotransmitters. As I mentioned previously, this is usually glutamate-based, and that leads to a diffuse injury to the brain, and this patient has a very, very poor prognosis. You see the large area of restricted diffusion on the ADC map affecting the thalamus as well as all these gray matter areas which have been injured not so much by the initial trauma as much as the expression of the glutamate which is toxic to the brain cells and leads to the diffuse injury. The patient got a subsequent CT scan. Again, you note that there isn't all that much damage apparent on the initial review of the CT scan, but you do see that absence of gray-white differentiation which is implying that the patient has had a diffuse injury to the cortex as well as the underlying white matter as demonstrated by the diffusion-wayed scan. This patient's brain is ademinis and swollen from that diffuse cytotoxic edema associated with shaken baby syndrome as an example of non-accidental trauma.