Shaken Baby Syndrome

Citation:

Blumenthal, I: Shaken Baby Syndrome. Postgraduate Medical Journal 78:732-735, December 2002.

Abstract

Notes:

• Improved neuropathology and imaging techniques have established the cause of brain injury as hypoxic ischaemic encephalopathy. Diffusion weighted MRI is the most sensitive and specific method of confirming a shaking injury.
• "The perpetrator is generally of limited patience and experience in handling a child."
• Most infants have evidence of impact.
• "It has not become possible to distinguish between hypoxic and traumatic axonal injury. The presence of B-amyloid precursor protein indicates survival of at least 2-3 hours, a point of medicolegal significance."
• The distinction between hypoxic and traumatic brain damage can be made. With violent shaking, the initial brain injury is caused by hypoxia. This causes cerebral edema and raised intracranial pressure. The initial cause of the hypoxia is respiratory difficulty.
• There is a wide spectrum of clinical signs. The mildest are non-specific and may persist for days or weeks: poor feeding, vomiting, lethargy, and irritability.
• "In the case of a severe injury, it is important to note that unlike an extradural hemorrhage, there is no lucid interval between the incident and loss of consciousness."
• It is not possible to date retinal hemorrhage.
• Non-traumatic causes of retinal hemorrhage include coagulation and hematological disorders, vasculopathies, and cranial malformations. They can also be caused by meningitis, intracranial hypertension, and some rare metabolic disorders. It should be noted that a head injury itself can cause a coagulation abnormality.
• Previous head circumference measurements have been shown to be crucial in identifying the time of the head trauma.
• When possible computed tomography should be complemented by MRI 2-3 days later. It is better at distinguising the age of hematomas in the case of repetitious injury.