Abusive head trauma

From Libre Pathology
Jump to navigation Jump to search

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

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.