Original article
Diffusion-weighted magnetic resonance imaging in shaken baby syndrome

Part of this study was presented at the AAPOS meeting (American Association for Pediatric Ophthalmology and Strabismus) in Orlando FL (March 2001) and at the NANOS meeting (North American Neuro-ophthalmology Society) in Palm Springs CA, May 2001.
https://doi.org/10.1016/S0002-9394(01)01366-6Get rights and content

Abstract

PURPOSE: To evaluate the role of diffusion-weighted magnetic resonance imaging (DWIMRI) in the diagnosis and management of children with suspected or confirmed Shaken Baby Syndrome (SBS).

METHODS: This was a retrospective interventional case series of all infants and children younger than 2 years of age admitted to a children’s hospital. We retrospectively reviewed medical records and neuroimaging findings of all children younger than 2 years of age with confirmed or suspected SBS admitted to a children’s hospital. Inclusion criteria were documented ocular examination by an ophthalmologist and a brain MRI with DWI. Twenty-six infants and children were included. Other children were excluded. Children with proven SBS were diagnosed with “confirmed SBS,” while children in whom the diagnosis of SBS remained uncertain were diagnosed with “suspected SBS.”

RESULTS: Twenty-six infants and children with mean age of 7.1 months (range, 6 weeks–24 months) were included, 18 with confirmed SBS. All 26 patients had a subdural hematoma, 10 had associated occult bone fractures, and 18 had retinal hemorrhages. Seven of the eight cases without retinal hemorrhages had isolated subdural hematoma without parenchymal brain lesions on both conventional MRI and DWIMRI. SBS was confirmed in only one case with a normal fundus. Among the 18 patients with retinal hemorrhages, SBS was confirmed in all but one case. All 18 patients with confirmed SBS had an abnormal DWIMRI. In 13 patients, DWI showed lesions that were larger than on conventional MRI. In patients with brain parenchymal lesions, the DWIMRI characteristics suggested cerebral ischemia, which appears to play a major role in SBS.

CONCLUSIONS: In all patients with confirmed SBS, DWIMRI was abnormal and suggested diffuse or posterior cerebral ischemia, in addition to subdural hematomas in the pathogenesis of this disorder.

Section snippets

Patients

: We retrospectively reviewed the medical records of all infants and children younger than 2 years of age with confirmed or suspected SBS admitted to Children’s Healthcare of Atlanta at Egleston Hospital between 1998 and 2000. Medical records were obtained from the Department of Neurosurgery and from the Department of Pediatric Ophthalmology registry data banks and were cross referenced with the records of the Child Protection Program and neuroradiology referral records to identify suspected

Results

A total of 26 infants and children were included. There were 14 boys and 12 girls with a mean age of 7 months (range, 6 weeks to 24 months). Among these 26 children, 18 had confirmed SBS, and 8 had suspected SBS. All patients had acute subdural hematoma as revealed by CT scanning. Skeletal survey demonstrated long bones or rib fractures in ten cases (38.5%). Retinal hemorrhages were found in 18 patients (69%) (unilateral in 3, bilateral in 15). One case had associated vitreous hemorrhage. All

Discussion

The diagnosis of SBS remains extremely challenging. Although recent successful murder prosecutions have increased public and professional awareness of SBS,27 the syndrome is still missed by physicians.28 Conversely, it is also sometimes overdiagnosed, and some children with subdural hematomas from other causes are erroneously suspected of having SBS and their parents or caregivers falsely accused of assault.27 The consequences of such an error may be grievous.

Injuries to the head pose special

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  • Cited by (0)

    This study was supported in part by a departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, New York, and by core grant P30-EY06360 (Department of Ophthalmology) from the National Institutes of Health, Bethesda, Maryland. Dr. Newman and Dr. Lambert are recipients of the Research to Prevent Blindness Lew R. Wasserman Merit Award.

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