Difference between revisions of "Abusive head trauma"

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This article covers '''abusive head trauma''' in infants.  It commonly goes by the name '''shaken baby syndrome'''.  An common alternate term is '''shaken-impact syndrome'''; this is advocated by some as it is uncertain with shaking alone is sufficient to cause the classic pattern of injuries.
This article covers '''abusive head trauma''' in infants.  It commonly goes by the name '''shaken baby syndrome''', abbreviated '''SBS'''.  A common alternate term is '''shaken-impact syndrome'''; this is advocated by some as it is uncertain shaking alone is sufficient to cause the classic pattern of injuries.


==Defining features==
==Defining features==
===Clinical triad===
===Clinical triad===
Classically described as:<ref name=pmid18365221>{{cite journal |author=Oehmichen M, Schleiss D, Pedal I, Saternus KS, Gerling I, Meissner C |title=Shaken baby syndrome: re-examination of diffuse axonal injury as cause of death |journal=Acta Neuropathol. |volume=116 |issue=3 |pages=317–29 |year=2008 |month=September |pmid=18365221 |doi=10.1007/s00401-008-0356-4 |url=}}</ref>
Classically described as:<ref name=pmid18365221>{{cite journal |author=Oehmichen M, Schleiss D, Pedal I, Saternus KS, Gerling I, Meissner C |title=Shaken baby syndrome: re-examination of diffuse axonal injury as cause of death |journal=Acta Neuropathol. |volume=116 |issue=3 |pages=317–29 |year=2008 |month=September |pmid=18365221 |doi=10.1007/s00401-008-0356-4 |url=}}</ref>
*Retinal haemorrhage.
#Retinal haemorrhage.
*[[Subdural hemorrhage]] (SDH).
#[[Subdural hemorrhage]] (SDH).
*Acute encephalopathy.
#Acute encephalopathy.
**Some say ''brain swelling''.<ref>David Ramsay. 9 September 2010.</ref>
#*Some say ''brain swelling''.<ref>David Ramsay. 9 September 2010.</ref>


===Pathologic triad===
===Pathologic triad===
*Subdural hemorrhage (SDH).
#Subdural hemorrhage (SDH).
**May be "thin film" type.
#*May be "thin film" type.
*Retinal hemorrhage/nerve sheath hemorrhage.<ref name=pmid18936952>PMID 18936952.</ref>
#Retinal hemorrhage/nerve sheath hemorrhage.<ref name=pmid18936952>{{Cite journal  | last1 = Matschke | first1 = J. | last2 = Püschel | first2 = K. | last3 = Glatzel | first3 = M. | title = Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury. | journal = Int J Legal Med | volume = 123 | issue = 3 | pages = 189-97 | month = May | year = 2009 | doi = 10.1007/s00414-008-0293-8 | PMID = 18936952 }}</ref>
*Hypoxic encephalopathy.
#Hypoxic encephalopathy.


===Other features===
===Other features===
Subcortical slit-like haemorrhages:<ref>URL: [http://books.google.com/books?id=0tZIcDDe6bAC&pg=PA481&lpg=PA481&dq=slit+white+matter+hemorrhage&source=bl&ots=1v-PVo2cmI&sig=HCnZBVYvyst8vC-ZcXL396pTrIk&hl=en&ei=oh2JTMy-NsSqlAf78qyBDg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBEQ6AEwADgK#v=onepage&q=slit%20white%20matter%20hemorrhage&f=false http://books.google.com/books?id=0tZIcDDe6bAC&pg=PA481&lpg=PA481&dq=slit+white+matter+hemorrhage&source=bl&ots=1v-PVo2cmI&sig=HCnZBVYvyst8vC-ZcXL396pTrIk&hl=en&ei=oh2JTMy-NsSqlAf78qyBDg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBEQ6AEwADgK#v=onepage&q=slit%20white%20matter%20hemorrhage&f=false]. Accessed on: 9 September 2010.</ref><ref>David Ramsay. 9 September 2010.</ref>
Subcortical slit-like hemorrhages:<ref>URL: [http://books.google.com/books?id=0tZIcDDe6bAC&pg=PA481&lpg=PA481&dq=slit+white+matter+hemorrhage&source=bl&ots=1v-PVo2cmI&sig=HCnZBVYvyst8vC-ZcXL396pTrIk&hl=en&ei=oh2JTMy-NsSqlAf78qyBDg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBEQ6AEwADgK#v=onepage&q=slit%20white%20matter%20hemorrhage&f=false http://books.google.com/books?id=0tZIcDDe6bAC&pg=PA481&lpg=PA481&dq=slit+white+matter+hemorrhage&source=bl&ots=1v-PVo2cmI&sig=HCnZBVYvyst8vC-ZcXL396pTrIk&hl=en&ei=oh2JTMy-NsSqlAf78qyBDg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBEQ6AEwADgK#v=onepage&q=slit%20white%20matter%20hemorrhage&f=false]. Accessed on: 9 September 2010.</ref><ref>David Ramsay. 9 September 2010.</ref>
*Classically frontal lobe.
*Classically frontal lobe.
*Shear force.
*Shear force.
*Associated with shaken baby.
*Associated with shaken baby syndrome.


==Related==
==Related==
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*Coagulopathy, as may be seen in sepsis.
*Coagulopathy, as may be seen in sepsis.
*Trauma.
*Trauma.
===Subcortical hemorrhage===
*Associated with cerebral vein thrombosis.<ref name=pmid7622677>{{Cite journal  | last1 = Keiper | first1 = MD. | last2 = Ng | first2 = SE. | last3 = Atlas | first3 = SW. | last4 = Grossman | first4 = RI. | title = Subcortical hemorrhage: marker for radiographically occult cerebral vein thrombosis on CT. | journal = J Comput Assist Tomogr | volume = 19 | issue = 4 | pages = 527-31 | month =  | year =  | doi =  | PMID = 7622677 }}</ref>


===Blood work of shock===
===Blood work of shock===

Latest revision as of 18:02, 20 May 2013

This article covers abusive head trauma in infants. It commonly goes by the name shaken baby syndrome, abbreviated SBS. A common alternate term is shaken-impact syndrome; this is advocated by some as it is uncertain shaking alone is sufficient to cause the classic pattern of injuries.

Defining features

Clinical triad

Classically described as:[1]

  1. Retinal haemorrhage.
  2. Subdural hemorrhage (SDH).
  3. Acute encephalopathy.
    • Some say brain swelling.[2]

Pathologic triad

  1. Subdural hemorrhage (SDH).
    • May be "thin film" type.
  2. Retinal hemorrhage/nerve sheath hemorrhage.[3]
  3. Hypoxic encephalopathy.

Other features

Subcortical slit-like hemorrhages:[4][5]

  • Classically frontal lobe.
  • Shear force.
  • Associated with shaken baby syndrome.

Related

Sinovenous thrombosis

  • Usually not associated with SDH.

DDx:

  • Coagulopathy, as may be seen in sepsis.
  • Trauma.

Subcortical hemorrhage

  • Associated with cerebral vein thrombosis.[6]

Blood work of shock

  • Glucose - high (IV fluids).
  • WBC - high.
  • LFTs - high (ischemia).
  • INR - high (dilutional).
  • Hb - low (dilutional).

Neonatal giant cell hepatitis

Main article: Neonatal giant cell hepatitis

See also

References

  1. ↑ Oehmichen M, Schleiss D, Pedal I, Saternus KS, Gerling I, Meissner C (September 2008). "Shaken baby syndrome: re-examination of diffuse axonal injury as cause of death". Acta Neuropathol. 116 (3): 317–29. doi:10.1007/s00401-008-0356-4. PMID 18365221.
  2. ↑ David Ramsay. 9 September 2010.
  3. ↑ Matschke, J.; Püschel, K.; Glatzel, M. (May 2009). "Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury.". Int J Legal Med 123 (3): 189-97. doi:10.1007/s00414-008-0293-8. PMID 18936952.
  4. ↑ URL: http://books.google.com/books?id=0tZIcDDe6bAC&pg=PA481&lpg=PA481&dq=slit+white+matter+hemorrhage&source=bl&ots=1v-PVo2cmI&sig=HCnZBVYvyst8vC-ZcXL396pTrIk&hl=en&ei=oh2JTMy-NsSqlAf78qyBDg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBEQ6AEwADgK#v=onepage&q=slit%20white%20matter%20hemorrhage&f=false. Accessed on: 9 September 2010.
  5. ↑ David Ramsay. 9 September 2010.
  6. ↑ Keiper, MD.; Ng, SE.; Atlas, SW.; Grossman, RI.. "Subcortical hemorrhage: marker for radiographically occult cerebral vein thrombosis on CT.". J Comput Assist Tomogr 19 (4): 527-31. PMID 7622677.
  7. ↑ Guddat, SS.; Ehrlich, E.; Martin, H.; Tsokos, M. (Sep 2011). "Fatal spontaneous subdural bleeding due to neonatal giant cell hepatitis: a rare differential diagnosis of shaken baby syndrome.". Forensic Sci Med Pathol 7 (3): 294-7. doi:10.1007/s12024-011-9227-8. PMID 21331818.
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