Difference between revisions of "Abusive head trauma"

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This article covers '''traumatic brain injury in infants''' that are suspected to be due to abuse, [[AKA]] '''shaken baby syndrome''' and '''shaken-impact syndrome'''.
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.


==Clinical triad<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>==
==Defining features==
*Retinal haemorrhage.
===Clinical triad===
*[[Subdural hematoma]] (SDH).
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>
*Acute encephalopathy.
#Retinal haemorrhage.
**Some say ''brain swelling''.<ref>David Ramsay. 9 September 2010.</ref>
#[[Subdural hemorrhage]] (SDH).
#Acute encephalopathy.
#*Some say ''brain swelling''.<ref>David Ramsay. 9 September 2010.</ref>


==Pathologic triad==
===Pathologic triad===
*Subdural haemorrhage (SDH).
#Subdural hemorrhage (SDH).
**May be "thin film" type.
#*May be "thin film" type.
*Nerve sheath hemorrhage<ref name=pmid18936952>PMID 18936952.</ref> (pathologic correlate to retinal hemorrhage).
#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.


===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==
===Sinovenous thrombosis===
===Sinovenous thrombosis===
*Usually not associated with SDH.
*Usually not associated with [[SDH]].


DDx:
DDx:
*Coagulopathy.
*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===
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*Hb - low (dilutional).
*Hb - low (dilutional).


===Neonatal giant cell hepatitis===
{{Main|Neonatal giant cell hepatitis}}
*Reported to be a cause of [[subdural hematoma]].<ref name=pmid21331818>{{Cite journal  | last1 = Guddat | first1 = SS. | last2 = Ehrlich | first2 = E. | last3 = Martin | first3 = H. | last4 = Tsokos | first4 = M. | title = Fatal spontaneous subdural bleeding due to neonatal giant cell hepatitis: a rare differential diagnosis of shaken baby syndrome. | journal = Forensic Sci Med Pathol | volume = 7 | issue = 3 | pages = 294-7 | month = Sep | year = 2011 | doi = 10.1007/s12024-011-9227-8 | PMID = 21331818 }}</ref>


==See also==
==See also==
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[[Category:Forensic pathology]]
[[Category:Forensic pathology]]
[[Category:Pediatric pathology]]
[[Category:Diagnosis]]

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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