[The shaken baby syndrome: a serious diagnosis on an insecure foundation?]

The discussion concerning the causes of infantile subdural bleedings (SDB) as well as retinal hemorrhages has become quite controversial in the last few years. The long-standing 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. In many cases, there are no objective witnesses who observed the incident and no unambiguous traces of abuse, so that the diagnosis "shaken baby syndrome" often has to be established indirectly. A subdural bleeding (SDB) in an infant can undoubtedly be due both to an accidental and an intentional injury. Therefore, the SDB itself does not allow to draw far-reaching conclusions as to its cause. However, if an infant died or was hospitalized in a deep coma with several bridging vein ruptures and minor subdural bleeding, these findings are not compatible with an alleged minor fall. In the presence of several bridging vein ruptures, most authors are of the opinion that this is the result of a significant traumatization. In contrast to most other reports, the reliable demonstration of BV ruptures is a routine element of the postmortem diagnostic procedures at the Berlin institute of forensic medicine. In this way, a mechanical trauma can be clearly identified as the cause of the infant's death. If several bridging veins are torn, this proves a significant trauma and rules out a banal incident. The current controversial discussion on the reliability of the SBS diagnosis often makes it difficult not only for the clinician, but also for the forensic expert, to draw safe conclusions in the presence of a combination of findings long considered typical of the shaken baby syndrome. This situation is the background for presenting and discussing the major SBS findings reported in the literature and comparing them with our own expiriences. In our opinion there is still no justification for a fundamental change in the position to interpret such cases as a consequence of severe trauma caused by another person.