[Nonaccidental traumatic brain injury in infants and children]

Area of Science:

• Pediatrics
• Neurology
• Forensic Medicine

Background:

• Violent traumatic brain injury (TBI) is a significant cause of childhood mortality globally.
• Nonaccidental trauma accounts for approximately 20% of TBI in children under two years old.
• Shaken impact syndrome results from violent shaking, causing severe brain and spinal cord injury.

Purpose of the Study:

• To highlight the mechanisms and consequences of nonaccidental TBI in children.
• To emphasize the severe clinical manifestations and long-term effects of shaken impact syndrome.
• To advocate for preventive measures, particularly educational interventions.

Main Methods:

• Review of clinical presentations and pathological findings associated with violent TBI in pediatric populations.
• Analysis of injury patterns, including vascular rupture, axonal shear injuries, and associated fractures.
• Correlation of clinical symptoms with increased intracranial pressure and brain stem involvement.

Main Results:

• Violent TBI can cause bridge vein rupture, axonal shear injuries, and brain swelling.
• Brain stem involvement may lead to respiratory arrest; symptoms include poor feeding, seizures, and vomiting.
• Long-term consequences encompass neurological, neuropsychological, visual, and auditory deficits, alongside poor academic performance.

Conclusions:

• Nonaccidental TBI, particularly shaken impact syndrome, carries a poor prognosis.
• Early recognition of symptoms like seizures, vomiting, and altered consciousness is critical.
• Preventive strategies, focusing on educating caregivers about the dangers of shaking, are essential.