Original articleDiffusion-weighted magnetic resonance imaging in shaken baby syndrome☆
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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Patterns of retinal hemorrhage associated with cardiac arrest and cardiopulmonary resuscitation
2021, Journal of AAPOSCitation Excerpt :In a study of retinal findings in 159 critically ill children, respiratory failure was associated with a lower likelihood of having RH, and nontraumatic encephalopathy had no association with RH.19 We previously examined the associations between hypoxic ischemic injury, intracranial hemorrhage, and RH severity, but our study did not have any cases of isolated hypoxic brain injury without trauma, so it was not possible to control for potential confounding.20 Strengths of our study include prospective enrollment of patients, ophthalmologist examinations performed through dilated pupils within a short time from cardiac arrest, and careful handling of the potential confounding posed by coincident causes of RH, including consideration of the patterns known to be associated with those causes.
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2019, Pediatric NeurologyVirtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging
2019, Seminars in Ultrasound, CT and MRICitation Excerpt :The names applied to the syndromes of inflicted head injury in infancy reflect the actions necessary to cause the types of injuries seen, such as shaking an infant held by the arms or trunk or forcefully striking an infant's head against a surface.55-59 Nevertheless, in living children, FR-MR should be preferred, for radiation protection issues: The use of diffusion-weighted magnetic resonance imaging allows the evaluation of the role of hypoxic-ischemic injury in traumatic pediatric head injuries.59-61 In conclusion, the indication for FR-CT imaging strongly depends on the applied technique, each of which has its advantages and disadvantages.
Infantile traumatic brain injury with a biphasic clinical course and late reduced diffusion
2018, Journal of the Neurological SciencesCitation Excerpt :The clinical and radiological features of the nine patients, therefore, are very similar to those of AESD, and we would call this type of brain injury infantile traumatic brain injury with a biphasic clinical course and late reduced diffusion (TBIRD). Diffuse cerebral ischemia (watershed infarction) was proposed as the pathomechanism of the restricted diffusion in 18 patients with AHT [1], however, this is unlikely because cerebral ischemia usually involves the deep white matter of watershed regions rather than the subcortical white matter. In addition, DWI on day 1 or 2 revealed no restricted diffusion, which is inevitably observed in patients with watershed infarction reflecting cytotoxic edema within 24 h [13].
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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.