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Published on: September 21, 2017
Position paper on fatal abusive head injuries in infants and young children
M E Case1, M A Graham, T C Handy
1Department of Pathology, St Louis University Health Sciences Center, Missouri 63104-8298, USA.
Insights
Abusive head injuries in children, including shaken baby syndrome, often result from rotational brain movement. Pathologic markers like subdural and retinal hemorrhages help identify shearing brain injuries in young children.
Area of Science:
- Pediatric Traumatology
- Forensic Pathology
- Neuropathology
Background:
- Abusive head injuries encompass shaking and impact trauma, with unique mechanisms in young children due to developmental differences.
- Inflicted head injuries in infants and young children frequently involve rotational brain movement within the cranial cavity.
Framework:
- Rotational brain movement generates shearing forces, leading to diffuse axonal injury, disruption of axons, and tearing of bridging veins.
- These shearing forces commonly result in subdural and subarachnoid hemorrhages, often accompanied by retinal schisis and hemorrhages.
Implementation:
- Understanding the rotational mechanism aids in recognizing clinical features of severe acute rotational brain injuries, such as decreased consciousness and respiratory distress.
- Pathologic findings, specifically subdural hemorrhage, subarachnoid hemorrhage, and retinal hemorrhages, serve as critical markers for identifying shearing brain injury.
Implications:
- Recognition of these "markers" is crucial for accurate diagnosis and intervention in cases of suspected abusive head trauma in young children.
- This understanding supports medical examiners and clinicians in identifying inflicted injuries and ensuring appropriate child protection measures.
Abstract:
This article represents the work of the National Association of Medical Examiners Ad Hoc Committee on shaken baby syndrome. Abusive head injuries include injuries caused by shaking as well as impact to the head, either by directly striking the head or by causing the head to strike another object or surface. Because of anatomic and developmental differences in the brain and skull of the young child, the mechanisms and types of injuries that affect the head differ from those that affect the older child or adult. The mechanism of injury produced by inflicted head injuries in these children is most often rotational movement of the brain within the cranial cavity. Rotational movement of the brain damages the nervous system by creating shearing forces, which cause diffuse axonal injury with disruption of axons and tearing of bridging veins, which causes subdural and subarachnoid hemorrhages, and is very commonly associated with retinal schisis and hemorrhages. Recognition of this mechanism of injury may be helpful in severe acute rotational brain injuries because it facilitates understanding of such clinical features as the decrease in the level of consciousness and respiratory distress seen in these injured children. The pathologic findings of subdural hemorrhage, subarachnoid hemorrhage, and retinal hemorrhages are offered as "markers" to assist in the recognition of the presence of shearing brain injury in young children.
