Shaken-baby Syndrome

Mechanism:
  • Angular / rotational deceleration causing cerebral concussion & subdural hematoma. It is the sudden angular deceleration experienced by the brain & cerebral vessels, not the specific contact forces applied to the surface of the head, that results in teh intracranial injury.
  • Trivial forces, eg. routine play, infant swings, fall from a low height are insufficient to cause the syndrome.
  • Restricted to <3yo
Risk factors:
  • Young parents, unstable family situations, low socioeconomic status
  • disability or prematurity of the child
Perpetrators:
  • father > BF > female babysitters > mother
Hx:
  • Vague history that varies with time
  • Mechanism of injury that is incompatible with the developmental capacity of the child
  • Impaired LOC, lethargy, irritability
  •  apnea, breathing abnormalities
  • Vomiting, poor feeding
  • Sz, increased/ decreased tone
PEx:
  • Bruising, swelling, soft-tissue injuries and burns
  • Cutaneous marks
  • Scalp hemorrhage, full fontanelle, retina hemorrhage (65-95%)
    • dx of inflicted head injury can’t rest on the finding of retinal hemorrhage alone
  • Lethargy, irritability, unresponsive
  • Meningismus
  • Opisthotonos / moribund
Ix
  • CT 
  • Plain skull x-ray – skull #
  • Skeletal survey: multiple or complex # 
    • posterior or lateral rib # & metaphyseal # are characteristic, but not pathognomonic
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Posted in 99 Priority Topics, Others

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