Pediatric abusive head trauma

Abstract

Abusive head trauma (AHT), used to be named shaken baby syndrome, is an injury to the skull and intracranial components of a baby or child younger than 5 years due to violent shaking and/or abrupt impact. It is a worldwide leading cause of fatal head injuries in children under 2 years. The mechanism of AHT includes shaking as well as impact, crushing or their various combinations through acceleration, deceleration and rotational force. The diagnosis of AHT should be based on the existence of multiple components including subdural hematoma, intracranial pathology, retinal hemorrhages as well as rib and other fractures consistent with the mechanism of trauma. The differential diagnosis must exclude those medical or surgical diseases that can mimic AHT such as traumatic brain injury, cerebral sinovenous thrombosis, and hypoxic-ischemic injury. As for the treatment, most of the care of AHT is supportive. Vital signs should be maintained. Intracranial pressure, if necessary, should be monitored and controlled to ensure adequate cerebral perfusion pressure. There are potential morbidity and mortality associated with AHT, ranging from mild learning disabilities to severe handicaps and death. The prognosis of patients with AHT correlates with the extent of injury identified on CT and MRI imaging. The outcome is associated with the clinical staging, the extent of increased intracranial pressure and the existence of neurological complications such as acquired hydrocephalus or microcephalus, cortical blindness, convulsive disorder, and developmental delay. AHT is a potentially preventable disease, therefore, prevention should be stressed in all encounters within the family, the society and all the healthcare providers.

Keywords: Abusive head trauma; Child; Infant; Neurocritical care; Shaken baby syndrome.

Fig. 1

Abusive head injury in a one-year-old female infant. (A) Right eye ground, (B) left eye ground showed diffuse intraretinal and preretinal hemorrhages, with some cotton-wool spots and moderate papilledema, more on left side. (C) Initial non-contrast CT demonstrated bilateral chronic subdural effusion plus (D) acute left subdural hematoma. Flair MRI (E) and (F) taken 2 weeks after bilateral subdural drainage demonstrated asymmetric subdural fluid collections, as well as several parenchymal ischemic changes over frontal lobes, basal ganglia (more on left) and posterior lobes.