Related Experiment Video
Updated: Aug 21, 2026
Automated Midline Shift and Intracranial Pressure Estimation based on Brain CT Images
Published on: April 13, 2013
Normal computerized tomography of brain in children with shaken baby syndrome
Yair Morad1, Isaac Avni, Scott A Benton
1Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel.
Insights
Shaken baby syndrome (SBS) can be diagnosed even with normal initial CT scans. Documenting retinal hemorrhages is crucial for diagnosis in these challenging shaken baby syndrome cases.
Area of Science:
- Pediatric neurology
- Child abuse and neglect research
- Forensic pediatrics
Background:
- Shaken baby syndrome (SBS) diagnosis can be challenging when initial neuroimaging is normal.
- Investigating clinical presentation and course of SBS with normal cranial computerized tomography (CT) is essential.
- This study aims to identify further diagnostic procedures for SBS in such cases.
Observation:
- Nine cases of SBS with normal initial CT scans were identified.
- All children presented with abnormal neurological examinations.
- Subdural hemorrhage was detected via MRI days later in some cases, and bone fractures were present in others.
Findings:
- Magnetic resonance imaging (MRI) revealed subdural hemorrhage in 4 of 9 cases several days after admission.
- Five children experienced long-term neurological damage.
- Diagnosis was confirmed through perpetrator confession, evolving brain abnormalities on imaging, inconsistent history, or social risk factors.
Implications:
- Normal initial CT scans do not exclude a diagnosis of SBS.
- Retinal hemorrhages are critical indicators for diagnosing SBS when CT is normal.
- Early and accurate diagnosis of SBS is vital for intervention and improving patient outcomes.
Objective:
To characterize the clinical presentation and clinical course of shaken baby syndrome (SBS) with normal cranial computerized tomography (CT) on admission and to suggest further diagnostic procedures in such circumstances.
Methods:
Using a worldwide listserv designed to facilitate discussion in the field of child abuse and neglect, we solicited case information for children hospitalized in different medical centers, who were diagnosed with SBS and had a normal CT scan on admission.
Results:
Nine cases were identified. While all children had an abnormal neurologic examination on admission, eight had a normal CT, and one had "widening of cranial sutures." In four cases, subdural hemorrhage was diagnosed on magnetic resonance imaging (MRI) 3 to 7 days after admission. Five children had bone fractures. The neurological outcome was normal in four of nine cases. Five children had long-term neurologic damage. The diagnosis of SBS was supported by either perpetrator confession, characteristic evolution of brain abnormalities on CT or MRI, inconsistent or absent explanatory history, and/or other social risk factors.
Conclusion:
The diagnosis of SBS can be established even when brain CT is normal on admission. The documentation of retinal hemorrhages is of primary importance in establishing the diagnosis of SBS in these cases.
Related Concept Videos
01:10Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
01:14Brain Imaging
These technologies include computerized axial tomography (CAT or CT scans), positron-emission tomography (PET scans), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and Transcranial Magnetic Stimulation (TMS).