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Updated: May 19, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
[Shaken baby syndrome: which lesions in imaging ?]
1Faculté de médecine, université Paris Descartes, 75006 Paris, France. c.adamsbaum@bct.aphp.fr
Insights
Non-accidental brain trauma, or shaken baby syndrome, is a leading cause of infant injury and death. Early diagnosis via CT scans and MRI is crucial for identifying brain injuries and preventing further harm.
Area of Science:
- Pediatric Traumatology
- Neuroradiology
- Child Abuse Forensics
Context:
- Non-accidental brain trauma (NBT), commonly known as shaken baby syndrome, is a primary cause of severe morbidity and mortality in infants.
- It predominantly affects infants under 8 months old, often resulting from violent shaking, sometimes with impact.
Purpose:
- To outline the diagnostic approach for non-accidental brain trauma in infants.
- To highlight key imaging findings and clinical signs indicative of abusive head trauma.
Summary:
- Emergency hospitalization and immediate brain CT are indicated for suspected NBT, revealing subdural hematomas.
- MRI is superior for analyzing intraparenchymal injuries, while 3D skull analysis detects fractures or swelling.
- Ophthalmologic exams are essential for identifying subtle retinal hemorrhages; bruising is common but not always present.
Impact:
- Accurate diagnosis of NBT is critical for timely intervention and management.
- Identifying "age different lesions" signifies repeated trauma, indicating a high risk of recurrence and informing protective measures.
Abstract:
Non-accidental brain trauma (also called shaken baby syndrome) represent the main cause for morbidity and mortality in the context of child abuse. It often occur in young infants aged less than 8months. The shaking leading to brain injuries are very violent and sometimes associated with a final impact. Intracranial injuries may be isolated without skeletal trauma or bruising. In any suspicion of such a diagnosis, emergency hospitalization is indicated. Brain CT, easy to perform in emergency, is the diagnostic key. It discloses diffuse subdural hematomas in typical sites as vertex, interhemispheric space and tentorium. There is no clear background of trauma and the related story is changing over time. The 3D analysis of the skull looks for signs of recent impact as a fracture that is sometimes complex and/or a soft tissue swelling of the scalp. Intraparenchymal injuries (contusions, tearing, and overall anoxic ischemic injuries) are better analyzed with MRI. The prognosis depends on their extent. Ophtalmologic examination is systematically performed looking for retinal hemorrhages (around one third of cases) which may be very subtle. Bruising is a major diagnostic sign, but inconstantly present. A precise datation of skeletal and/or brain injuries is not possible with imaging and the only indication of use is to establish the presence of "age different lesions". This indicates repeated trauma and thereby a high risk of recurrence.
