Abusive head trauma

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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.


Sinovenous thrombosis

  • Usually not associated with SDH.


  • 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


  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.