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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