Shaken baby syndrome diagnosed by magnetic resonance imaging

We report an infant with Shaken Baby syndrome (SBS) who presented with status epilepticus. The initial evaluation with computerized axial tomography (CAT scan) of the head was normal, and there was no history or physical finding consistent with physical abuse or shaking. This prompted an extensive evaluation to determine the etiology of the seizures. An ophthalmology consultation revealed the presence of severe bilateral retinal hemorrhages, which raised the possibility of SBS. Magnetic resonance imaging (MRI) showed cerebral hemorrhages, hemorrhagic contusions, and bilateral subtemporal subdural hematomas. This is the first reported case of SBS diagnosed by magnetic resonance imaging following a normal initial CAT scan. MRI may be a valuable tool in the diagnosis of brain injury in SBS and may be particularly valuable when the CAT scan of the head is normal, the etiology of neurologic injury is unclear, and the presence of retinal hemorrhages raises the suspicion of SBS.