Lethal subdural bleedings of babies--accident or abuse?

The discussion concerning the causes of infantile subdural bleedings (SDB) has become quite controversial in recent years. The interpretation that most of these cases are the result of abuse, especially by the shaken baby syndrome (SBS), was doubted, and the role of accidental events was emphasized. Because of the lack of a reliable history and insignificant other findings, the conclusion of a SBS is not seldom drawn indirectly. In contrast to most other reports, the reliable demonstration of bridging vein (BV) ruptures is a standard element of postmortem diagnostics in our institute. In this way, a mechanical trauma can be identified as the cause of the child's death without any doubt, and if several BVs are torn, a trauma of significant degree can be concluded. Our methods of investigation are presented and typical examples are imaged. Furthermore, the occurrence of accidental and non-accidental lethal head injuries of infants and toddlers (up to 5 years old) in the city of Berlin has been analyzed, based on the official statistics of the causes of death in the city of Berlin (1978-1998) and the autopsy material of our institute (1978-1999). In this period, not a single death of a child due to an undoubted minor fall was recorded.