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Neurological manifestations in abused children who have been shaken
Insights
Shaken infant syndrome can cause severe brain damage and blindness, even without skull fractures. Extensive retinal hemorrhages are a key indicator, suggesting increased intrathoracic pressure leading to brain injury.
Area of Science:
- Pediatrics
- Neurology
- Forensic Medicine
Background:
- Shaken infant syndrome (SIS) is a severe form of abusive head trauma.
- Classical signs like skull fractures or subdural hematomas may be absent in some SIS cases.
Abstract:
Four infants with the 'shaken infant syndrome' are described. None had skull fractures and only one had a subdural hematoma. All had extensive retinal and pre-retinal hemorrhages. Follow-up computerized tomography showed severe brain atrophy, multiple hypodense areas and ventricular enlargement. Three of the patients suffered severe, permanent brain damage, with mental retardation, spasticity and blindness. It is suggested that the underlying pathogenesis of this syndrome is acutely increased intrathoracic pressure, transmitted into the head to cause multiple venous infarctions. Retinal and pre-retinal hemorrhages are cardinal features of this syndrome and their presence should raise the suspicion of this form of battering in the absence of the 'classical' signs of battering.