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Abusive head trauma (view source)

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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 haemorrhage (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.
==Pathologic triad==
#*Some say ''brain swelling''.<ref>David Ramsay. 9 September 2010.</ref>
*Subdural haemorrhage (SDH).
**May be "thin film" type.
*Nerve sheath hemorrhage<ref name=pmid18936952>PMID 18936952.</ref> (pathologic correlate to retinal hemorrhage).
*???


===Pathologic triad===
#Subdural hemorrhage (SDH).
#*May be "thin film" type.
#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==
===Sinovenous thrombosis===
*Usually not associated with [[SDH]].
 
DDx:
*Coagulopathy, as may be seen in sepsis.
*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===
*Glucose - high (IV fluids).
*WBC - high.
*LFTs - high (ischemia).
*INR - high (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]]
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