[Refractory status epilepticus presenting as shaken baby syndrome]

Area of Science:

• Pediatrics
• Neurology
• Forensic Medicine

Background:

• Convulsive status in infants often stems from febrile illnesses or central nervous system infections.
• Shaken baby syndrome (SBS) presents with specific signs like bilateral hemorrhages and encephalopathy, particularly in infants under one year.
• Febrile syndromes and conditions causing increased crying can precipitate infant shaking.

Observation:

• Two infant cases presented with status epilepticus during a febrile syndrome.
• Imaging revealed bilateral subdural hematomas in varying stages of development.
• Ophthalmic examination showed bilateral retinal hemorrhages in both infants.

Findings:

• The presented cases highlight a correlation between febrile illness, status epilepticus, and signs consistent with shaken baby syndrome.
• Bilateral subdural and retinal hemorrhages are critical indicators in diagnosing SBS in infants with seizures.
• Early recognition of SBS is crucial, especially in infants under six months experiencing febrile seizures.

Implications:

• Clinicians should consider shaken baby syndrome in infants presenting with convulsive status, even with seemingly common febrile illnesses.
• Prompt diagnosis and intervention for SBS can mitigate severe neurological damage and improve outcomes.
• This underscores the importance of a high index of suspicion for non-accidental trauma in infants with unexplained neurological events.