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Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Non-accidental fatal head injury in small children--a clinico-pathological correlation
A R Nooraudah1, K Mohd Sham, N Zahari
1Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, UPM Serdang Selangor.
Insights
Non-accidental head injuries are a leading cause of death in young children. Violent shaking, with or without direct impact, is the most frequent cause of fatal intracranial trauma in abused children.
Area of Science:
- Pediatric Forensic Pathology
- Child Abuse and Neglect
- Traumatic Brain Injury
Background:
- Non-accidental head injury is a significant cause of mortality in young children.
- Shaken impact syndrome involves violent shaking leading to subdural bleeding and cerebral hypoxia.
- Understanding injury mechanisms is crucial for diagnosis and prevention.
Purpose of the Study:
- To investigate the mechanisms of fatal intracranial trauma in children under 3 years old.
- To differentiate between shaking injuries and direct impact trauma.
- To establish the frequency of different injury types in fatal child abuse cases.
Main Methods:
- Retrospective analysis of pediatric deaths due to non-accidental injuries at Hospital Kuala Lumpur in 1999.
- Inclusion criteria: children under 3 years admitted with fatal non-accidental injuries.
- Postmortem examinations, including histopathological studies, were performed to determine injury mechanisms.
Main Results:
- Ten cases of fatal non-accidental head injury were identified.
- Two infants (under 1 year) showed evidence of violent shaking only.
- Six children (average age 13 months) exhibited signs of both direct trauma and shaking.
- Two older children (24 and 33 months) had direct head trauma without shaking.
Conclusions:
- Intracranial trauma from shaking, with or without direct impact, is the primary cause of mortality in abused children.
- Fatalities solely due to direct impact trauma are less common.
- This highlights the critical role of recognizing shaken impact syndrome in pediatric fatalities.
Abstract:
Non-accidental head injury leading to massive intracranial trauma has been identified as a leading cause of death in small children. In a typical case, a child usually below the age of one year is violently shaken, leading to rupture of the connecting veins between the dura mater and the brain substance with variable degrees of bleeding into the subdural space resulting in increased intracranial pressure. The accompanying venous thrombosis affecting the vessels of the brain substance leads to cerebral hypoxia and cellular death. In this study conducted throughout the year 1999, all children below the age of 3 years who were admitted to Hospital Kuala Lumpur and had died due to non-accidental injuries were included. Postmortems, including histopathological studies, were conducted to determine the most likely mechanisms of the injuries. Ten cases were identified for the whole year. In 2 cases, both below one year of age, the features presented showed evidence of violent shaking of the infants. In 6 other cases whose average age was 13 (range 4-24) months, there were evidences of direct trauma and violent shaking. In the last two cases, aged 24 and 33 months respectively, there was only evidence of direct trauma on the heads without being shaken. This study shows that death due to intracranial trauma caused by shaking with or without direct impact is the most frequent cause of mortality in abused children. Death due to direct impact between the head and another object is a less frequent occurrence.
