Infant ; Humans ; Shaken Baby Syndrome

Head injury in the youngest age group is distinct from that occurring in older children or adults because of differences in mechanisms, injury thresholds, and the frequency with which the question of child abuse is encountered. "Shaken baby syndrome" has results in intracranial and introcular hemorrhages with no evidence of external trauma. The cause of these injuries is vigorous shaking of an infant being held by the chest, shoulders, or extremities. Severe head injuries commonly diagnosed as shaking injuries require impact to occur and that shaking alone in an otherwise normal baby is unlikely to cause the shaken baby syndrome. "Shaken impact syndrome" has the advantage of being more inclusive of verifiable impact mechanisms and of reflecting the extreme forces that appear to be necessary to produce these often devastating injuries. All clinicians must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation. And physicians play an important role in diagnosis, management and prevention of child abuse and shaken baby syndrome.
Adult ; Child ; Child Abuse ; Craniocerebral Trauma ; Diagnosis ; Extremities ; Hemorrhage ; Humans ; Infant ; Shaken Baby Syndrome* ; Shoulder ; Thorax

Shaken baby syndrome develop as a form of child abuse, with the majority of cases occurring during the first year of life. It results from extreme rotational cranial acceleration and deceleration effects induced by violent shaking of an infant. The characteristic injuries include subdural and subarachnoid hemorrhages, and retinal hemorrhages. We experienced three cases of shaken baby syndrome. Although the history of trauma was little known, all of these cases had subdural hemorrhages. We present the cases with a review of related literature.
Acceleration ; Child ; Child Abuse ; Deceleration ; Hematoma, Subdural ; Humans ; Infant ; Retinal Hemorrhage ; Shaken Baby Syndrome* ; Subarachnoid Hemorrhage

Shaken baby syndrome refers to the group of nonaccidental injuries occuring in infants and children as a consequence of violent shaking. The characteristic injuries include subdural and subarachnoid hemorrhages, retinal hemorrhages, traction-typed metaphyseal fracture of long bone and fractures of the ribs. General physical findings may include bruising and burns, but sometimes no extracranial injuries are detected. Affected children are nearly always under 2 years of age or younger. Common symptoms include lethargy, irritability, seizures, increased or decreased muscle tone, poor feeding, impaired consciousness, vomiting and apnea. We experienced a case of shaken baby syndrome in a 3-month-old girl. Although the history of trauma(shaking) is little known, our findings of clinical and radiographic features corresponded to shaken baby syndrome. (J Korean Pediatr Soc 2000;43:851-855)
Apnea ; Burns ; Child ; Consciousness ; Female ; Humans ; Infant ; Lethargy ; Muscle Hypotonia ; Retinal Hemorrhage ; Ribs ; Seizures ; Shaken Baby Syndrome* ; Subarachnoid Hemorrhage ; Vomiting

PURPOSE: Non-accidental intracranial hemorrhage in children is not low in incidence and results in high mortality and serious sequelae. So, the authors have researched the distribution of sex and age, causes, symptoms and signs, hemorrhagic types, mortality rate and sequelae of the patients hospitalized with non-accidental intracranial hemorrhage at Hallym University Sacred Heart Hospital. METHODS: The medical records of twenty patients, aged 15 or younger, and excluding neonatal patients, were analyzed retrospectively. The patients in this study were admitted with non-accidental intracranial hemorrhage from January 1999 to June 2002. RESULTS: Of the twenty cases, the ratio of male to female was 1 : 0.8. The patients aged one or less and between 11 and 15 were discovered to be the most frequent cases. Shaken baby syndrome and arteriovenous malformation were found to be the most frequent causes. Seizure was most frequently found to be a symptom and a sign. Hemorrhagic type was classified into subdural hemorrhage eight, intracerebral hemorrhage five. There were three mortal cases. Twelve surviving patients, excluding five not-followed ones, were reclassified into six cases of complete recovery and six of sequalae. CONCLUSION: Non-accidental intracranial hemorrhage in children is not low in incidence, with a high mortality rate and a high incidence of serious sequelae after survival. Consequently, early diagnosis and appropriate treatment are required. In addition, appropriate rehabilitation after treatment is needed because the high survival rate due to advanced medical treatment results in an increasing number of neurologic sequelae.
Arteriovenous Malformations ; Cerebral Hemorrhage ; Child* ; Early Diagnosis ; Female ; Heart ; Hematoma, Subdural ; Humans ; Incidence ; Intracranial Hemorrhages* ; Male ; Medical Records ; Mortality ; Rehabilitation ; Retrospective Studies ; Seizures ; Shaken Baby Syndrome ; Survival Rate

PURPOSE: Shaken baby syndrome (SBS) can be developed by shaking a baby violently as a serious form of child abuse. It is found frequently among babies younger than two years old, particularly less than six months old. The syndrome is hardly diagnosed because it is found when the parents or baby-sitters tend to disguise the intention of abuse. The authors have experienced a case of shaken baby syndrome in 3 months old infant without the external signs of trauma and we herein report a case of SBS with a review of related literatures. METHODS: Three months old female infant was admitted for convulsion without fever. Magnetic resonance imaging showed subdural hemorrhage and funduscopic examination showed bilateral retinal hemorrhage. CONCLUSIONS: Ocular examination including funduscopy is important because SBS is difficult to be diagnosed. Ophthalmologist may play an important role in the diagnosis of this syndrome.
Child ; Child Abuse ; Diagnosis ; Female ; Fever ; Hematoma, Subdural ; Humans ; Infant ; Intention ; Magnetic Resonance Imaging ; Parents ; Retinal Hemorrhage ; Seizures ; Shaken Baby Syndrome*

PURPOSE: To report fundus photography using a smartphone in an infant with abusive head trauma. CASE SUMMARY: An 8-month-old male infant presented to the emergency room with decreased consciousness and epileptic seizures that the parents attributed to a fall from a chair. He had no external wounds or fractures to the skull or elsewhere. However, computerized tomography of the brain revealed an acute subdural hematoma in the right cranial convexity and diffuse cerebral edema, leading to a midline shift to the left and effacement of the right lateral ventricle and basal cistern. The attending neurosurgeon promptly administered a decompressive craniectomy. Immediately after the emergency surgery, a fundus examination revealed numerous multi-layered retinal hemorrhages in the posterior pole extending to the periphery in each eye. He also had white retinal ridges with cherry hemorrhages in both eyes. We acquired retinal photographs using the native camera of a smartphone in video mode. The photographer held the smartphone with one hand, facing the patient's eye at 15–20 cm, and held a 20 diopter condensing lens at 5 cm from the eye in the other hand. Our documentation using a smartphone led to a diagnosis of abusive head trauma and to obtain the criminal's confession, because the findings were specific for repetitive acceleration-deceleration forces to an infant`s eye with a strong vitreoretinal attachment. CONCLUSIONS: This ophthalmic finding had a key role in the diagnosis of abusive head trauma. This case presented the diagnostic use of a smartphone for fundus photography in this important medicolegal case.
Brain ; Brain Edema ; Consciousness ; Craniocerebral Trauma* ; Decompressive Craniectomy ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Epilepsy ; Hand ; Head* ; Hematoma, Subdural, Acute ; Hemorrhage ; Humans ; Infant* ; Lateral Ventricles ; Male ; Neurosurgeons ; Parents ; Photography* ; Retinal Hemorrhage ; Retinaldehyde ; Shaken Baby Syndrome ; Skull ; Smartphone* ; Wounds and Injuries

Shaken baby syndrome (SBS) is an extremely serious form of abusive head trauma that occurs when infants are subjected to rapid acceleration, deceleration, and rotational forces, with or without impact, resulting in a unique constellation of fractures, intracranial hemorrhages, and intraocular hemorrhages. Presenting complaints are often nonspecific; hence, it is important that all health care providers be able to recognize the clinical features that constitute SBS. Infants who have been shaken and injured have a high mortality rate. Approximately 25% of shaken babies die from their traumatic brain injuries. The infants who do not die may have permanent, often severe damage to their vision, hearing, thinking, and learning capabilities. They may be blind, have seizures, have spasticity, have small heads with lack of growth of brain tissues, and may be severely mentally retarded. Prevention is the best care for SBS, and community education of parents and guardians may reduce the incidence of SBS. We report a case of SBS without external signs of trauma.
Acceleration ; Brain ; Brain Injuries ; Craniocerebral Trauma ; Deceleration ; Education ; Head ; Health Personnel ; Hearing ; Hemorrhage ; Humans ; Incidence ; Infant ; Intracranial Hemorrhages ; Learning ; Mentally Disabled Persons ; Mortality ; Muscle Spasticity ; Parents ; Seizures ; Shaken Baby Syndrome* ; Thinking

Shaken baby syndrome is a serious form of child abuse, mostly involving children younger than 2 years. It results from extreme rotational cranial acceleration induced by violent shaking. The characteristic injuries include subdural hemorrhage, retinal hemorrhage, and fracture of ribs or long bones. If physicians have no recognition of, or suspicion about, shaken baby syndrome, this syndome is difficult to diagnosis because of a lack of obvious external signs and failure of the abuser to admit his or her actions. In addition to the high mortality, 60% of survivors have significant long term neurologic and developmental abnormality. The authors experienced five cases of shaken baby syndrome presented with seizures or vomiting, without external signs of trauma. All of these cases had subdural hemorrhages, and four cases had retinal hemorrahges. In our follow up, two children were found to have sequelae such as quadriplegia, monoplegia, and developmental delay. We emphasize that early recognition and prompt treament are key to overall success of case management. The incidence of shaken baby syndrome can be reduced through public awareness and education of parents not to shake a babies.
Acceleration ; Case Management ; Child ; Child Abuse ; Diagnosis ; Education ; Follow-Up Studies ; Hematoma, Subdural ; Hemiplegia ; Humans ; Incidence ; Mortality ; Parents ; Quadriplegia ; Retinal Hemorrhage ; Retinaldehyde ; Ribs ; Seizures ; Shaken Baby Syndrome* ; Survivors ; Vomiting