Difference between revisions of "Abusive head trauma"

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===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>PMID 18936952.</ref>
*Hypoxic encephalopathy.
#Hypoxic encephalopathy.


===Other features===
===Other features===

Revision as of 14:57, 25 March 2012

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.

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 haemorrhages:[4][5]

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

Related

Sinovenous thrombosis

  • Usually not associated with SDH.

DDx:

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

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. ↑ 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. ↑ 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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