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[Intracranial hemorrhages in infants: child abuse or a congenital coagulation disorder?]
K P Bach1, A Y Schouten-van Meeteren, L M Smit
1Academisch Ziekenhuis Vrije Universiteit, afd. Kindergeneeskunde, Postbus 7057, 1007 MB Amsterdam.
Insights
Discrepancies in neurological symptoms and examination findings in children can indicate abuse or rare congenital coagulation disorders. Prompt coagulation testing is crucial for accurate diagnosis and appropriate care, preventing misdiagnosis of child abuse.
Area of Science:
- Pediatrics
- Neurology
- Hematology
Background:
- Neurological symptoms in children with head injuries should correlate with examination findings.
- Discrepancies may suggest non-accidental head trauma (child abuse).
- Intracranial hemorrhages without significant trauma are often indicative of abuse.
Observation:
- Three infants presented with severe neurological symptoms and intracranial hemorrhages but no external head trauma.
- One infant was diagnosed with shaken baby syndrome.
- Two infants were diagnosed with congenital coagulation disorders: hemophilia B and factor V deficiency.
Findings:
- Congenital coagulation disorders can mimic the presentation of child abuse, including intracranial hemorrhages.
- Both conditions can lead to similar neurological symptoms and radiological findings.
- Early identification of coagulation disorders is critical.
Implications:
- Mandatory coagulation testing is essential for children with unexplained intracranial hemorrhages.
- Abnormal results allow for timely substitution therapy, improving outcomes.
- Accurate diagnosis prevents inappropriate accusations of child abuse against caregivers.
Abstract:
In children with head injuries the severity of the neurological symptoms should concord with the patient's history and signs of neurotrauma on examination. Discrepancies between the (hetero)anamnesis and physical examination on the one hand and neurological findings on the other may indicate child abuse. The presence of both old and new intracranial haemorrhages in the absence of proportional trauma is generally considered as evidence for child abuse. However, these symptoms may also be the first manifestation of a congenital coagulation disorder. Three children, two girls aged 8 and 5 months and a boy aged 6 months were presented with alarming neurological symptoms due to intracranial haemorrhages without external signs of head trauma. The first girl had 'shaken baby' syndrome while the other 2 had congenital coagulation disorders (haemophilia B and factor V deficiency, respectively). All three recovered, the last two with remaining one-sided neurological deficits. Child abuse and congenital coagulation disorders may present with similar neurological symptoms and radiological findings. In these patients coagulation tests are mandatory and--if abnormal--enable early substitution of deficits and prevent inappropriate suspicion or accusation of caretakers.