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
Leave a Reply