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The infant whiplash-shake injury syndrome: a clinical and pathological study
M N Hadley1, V K Sonntag, H L Rekate
1Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.
Insights
Severe whiplash-shake injuries in infants can cause profound neurological impairment without skull fractures. High cervical spinal cord injuries, including hematomas and contusions, contribute significantly to infant morbidity and mortality.
Area of Science:
- Pediatric Traumatology
- Neuropathology
- Forensic Medicine
Background:
- Nonaccidental trauma in infants often presents with severe neurological deficits.
- Classic shaken-baby syndrome injuries include intracranial hemorrhages and retinal hemorrhages.
- The role of direct cranial trauma versus indirect mechanisms in these injuries requires further elucidation.
Purpose of the Study:
- To investigate the injury patterns in infants with nonaccidental trauma, focusing on the presence of direct cranial trauma.
- To determine the contribution of cervical spinal cord injuries to the clinical presentation and outcomes.
- To evaluate the injury mechanism in severe whiplash-shake injuries.
Main Methods:
- Retrospective review of 13 infant cases with nonaccidental trauma (median age, 3 months).
- Detailed analysis of clinical presentations, including neurological status, seizures, and hemorrhages.
- Autopsy findings in 6 of 8 deceased infants were specifically examined for cranial and cervical spinal cord injuries.
Main Results:
- All infants presented with profound neurological impairment, seizures, and intracranial hemorrhages.
- None of the infants had skull fractures, and only one had an extracranial contusion.
- Five of six autopsied infants showed sub- or epidural hematomas and contusions at the cervicomedullary junction of the cervical spinal cord.
Conclusions:
- Direct cranial trauma is not a necessary component of the injury mechanism in severe whiplash-shake injuries in young children.
- Hemorrhages and contusions of the high cervical spinal cord are significant findings that may contribute to the high morbidity and mortality.
- These findings expand the understanding of shaken-baby syndrome pathology beyond classic intracranial and retinal injuries.
Abstract:
The cases of 13 infants (median age, 3 months) who sustained nonaccidental trauma were reviewed. All presented with profound neurological impairment, seizures, retinal hemorrhages, and intracranial subarachnoid and/or subdural hemorrhages. Of 8 infants who died, autopsy was performed on 6. No patient had a skull fracture, and only one had an extracalvarial contusion. Five of the 6 patients on whom autopsy was performed had injuries at the cervicomedullary junction consisting of sub- or epidural hematomas of the cervical spinal cord with proximal spinal cord contusions. The authors conclude that direct cranial trauma is not an essential element of the injury mechanism in young patients who sustain severe whiplash-shake injuries. In addition to the classic injuries reported to occur with the shaken-baby syndrome, hemorrhages and contusions of the high cervical spinal cord may contribute to morbidity and mortality.