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Published on: April 13, 2013
Shaken baby syndrome without intracranial hemorrhage on initial computed tomography
Yair Morad1, Isaac Avni, Louise Capra
1Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel.
Insights
Shaken baby syndrome (SBS) can be diagnosed without intracranial hemorrhage on CT scans. These cases, marked by severe cerebral edema and retinal hemorrhages, have a grave prognosis with high mortality.
Area of Science:
- Pediatrics
- Neurology
- Forensic Medicine
Background:
- Shaken baby syndrome (SBS), a form of abusive head trauma, is typically associated with intracranial hemorrhage.
- Cranial computerized tomography (CT) is a key diagnostic tool for identifying intracranial bleeding.
Observation:
- This study identified eight pediatric cases diagnosed with SBS despite the absence of intracranial hemorrhage on initial CT scans.
- All identified cases presented with cerebral edema on CT, severe in 88% of instances.
- Extensive retinal hemorrhages were present in all observed cases.
Findings:
- The diagnosis of SBS is possible even when initial CT scans do not reveal intracranial hemorrhage.
- Cerebral edema may lead to increased intracranial pressure, potentially preventing intracranial blood accumulation.
- These specific SBS cases exhibit a grave prognosis, with a 63% mortality rate observed in the study cohort.
Implications:
- Highlights the importance of considering SBS in the differential diagnosis of abusive head trauma, even with negative CT findings for hemorrhage.
- Suggests that cerebral edema can be a primary indicator of abusive head trauma in the absence of visible intracranial bleeding.
- Emphasizes the critical need for prompt recognition and intervention due to the severe outcomes associated with these SBS presentations.
Objective:
We sought to describe the unique characteristics of children diagnosed with shaken baby syndrome (SBS) despite the absence of intracranial hemorrhage on cranial computerized tomography (CT) on hospital admission.
Methods:
Using an international e-mail-based listserv for professionals with an interest in child abuse, we identified and reviewed the charts of children hospitalized in different medical centers who were diagnosed with SBS although CT disclosed no signs of intracranial bleeding. Children with normal imaging were not included.
Results:
Eight cases were identified. All children had cerebral edema in CT, which was severe on 7/8 cases (88%). All of these children had extensive retinal hemorrhage. The prognosis was poor; 5/8 infants died (63% mortality), and the rest had permanent neurologic damage.
Conclusion:
The diagnosis of SBS can be established even when CT at presentation does not demonstrate intracranial hemorrhage. We hypothesize that rapidly developing cerebral edema may cause increased intracranial pressure and tamponade that prevents the accumulation of intracranial blood. The prognosis in these cases is grave.
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