Difference between revisions of "Abusive head trauma"
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This article covers ''' | 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. | ||
==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== | ||
===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> | |||
*Retinal haemorrhage. | *Retinal haemorrhage. | ||
*[[Subdural | *[[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 | *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> | ||
| Line 21: | Line 23: | ||
==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. | ||
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[[Category:Forensic pathology]] | [[Category:Forensic pathology]] | ||
[[Category:Pediatric pathology]] | |||
[[Category:Diagnosis]] | |||
Revision as of 14:55, 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]
- Retinal haemorrhage.
- Subdural hemorrhage (SDH).
- Acute encephalopathy.
- Some say brain swelling.[2]
Pathologic triad
- Subdural hemorrhage (SDH).
- May be "thin film" type.
- Retinal hemorrhage/nerve sheath hemorrhage.[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
- Reported to be a cause of subdural hematoma.[6]
See also
References
- ↑ 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.
- ↑ David Ramsay. 9 September 2010.
- ↑ PMID 18936952.
- ↑ 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.
- ↑ David Ramsay. 9 September 2010.
- ↑ 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.