A Witnessed Short Fall Mimicking Presumed Shaken Baby Syndrome (Inflicted Childhood Neurotrauma)

Gardner, Horace B.

doi:10.1159/000106399

Cited by 26 publications

(21 citation statements)

References 11 publications

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“…This article [9] presents the case of an 11-month-old child who sustains a left fronto-temporo-parietal subdural hematoma and retinal hemorrhages from a short fall witnessed by a 5-year-old sibling. This mechanism was deemed adequate to explain the child’s significant intracranial bleeding and retinal hemorrhages, which were typical of inflicted head injury.…”

Section: Article Reviewsmentioning

confidence: 99%

“…The first, 31 h after injury, revealed ‘diffuse pre-/intraretinal hemorrhages, mostly posterior pole’ [9], and then 1 week later the same examiner noted ‘4 quadrants of bilateral pre- and intraretinal dot, flame-shaped hemorrhages OU – hemorrhages extend beyond equator – difficult to ascertain whether they extend to ora serrata’ [9]. The author then states that in deposition (a legal proceeding) there were multiple layered hemorrhages that extended to the periphery.…”

Section: Article Reviewsmentioning

confidence: 99%

“…In instances where perpetrator confessions have been obtained and reviewed, all of the children who were purposefully injured had subdural hemorrhage and retinal hemorrhages [13]. Gardner’s [9] claim that ocular findings can occur without shaking and ‘are of no value in determining etiology’ is not supported by published data.…”

Section: Article Reviewsmentioning

confidence: 99%

“…The author indicates that there was concern for benign external hydrocephalus, which is not definitively diagnosed. The preoperative CT scan was read as acute and chronic subdural hematoma [9], yet the surgeon felt that the subarachnoid space was enlarged intraoperatively. The diagnosis of benign external hydrocephalus is entertained but not demonstrated adequately and cannot wholly explain the findings.…”

Section: Article Reviewsmentioning

confidence: 99%

“…The author attempts to substantiate his claim that these injuries were not inflicted by presenting that the family was found to be a ‘stable one’ [9] and that a skeletal survey was normal. A proper psychosocial screen includes knowledge of prior child welfare involvement and multiple other psychosocial risk factors.…”

Section: Article Reviewsmentioning

confidence: 99%

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Inflicted Traumatic Brain Injury: Advances in Evaluation and Collaborative Diagnosis

Glick

Staley²

2007

Pediatr Neurosurg

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The determination that a traumatic brain injury is not accidental requires data collection from multiple domains: historical, clinical, laboratory, radiographic, environmental and psychosocial. These essential, yet disparate, types of information must be synthesized in a collaborative and interdisciplinary process to formulate a medical opinion with regard to the cause of an injury, and the final opinion has tremendous consequences for children and families. Medically directed child protection teams have emerged as the standard of care in many children’s hospitals and child abuse pediatrics is now a recognized medical subspecialty with board certification available in the next several years. Not only do the child and family benefit from this coordinated effort, but there are also great benefits for the members of the child protection team: more clearly defined responsibilities, redirected focus on treatment for the surgeon, and increased confidence that the opinion is based upon consensus and current scientific knowledge. By this process and its division of labor, the child abuse pediatrician assumes responsibility for ensuring that a final medical opinion is arrived at, and then advocates for appropriate disposition for the child. The child abuse pediatrician is responsible for establishing institutional standards for family evaluation, collecting all necessary medical data and directing a consensus-based decision making process that is based upon current medical knowledge, medical literature and experience. The child abuse pediatrician also assumes the role of primary communication conduit for investigational agencies and the courts. The neurosurgeon is a key member of the child protection team and relies on the team to obtain necessary historical information to address consistency of the mechanism with the sustained injuries and has an integral role in determining the team’s final opinion. An interdisciplinary response to inflicted traumatic brain injury is the cornerstone for establishing a rigorous standard of care; it also fosters education across medical subspecialties where controversy has been a significant part of the landscape. Valid and useful clinical research that describes head injury as accidental or inflicted can only be performed in the context of an interdisciplinary, medically directed child protection team that strives for objectivity and precision in the determination of the manner of an injury.

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Section: Article Reviewsmentioning

confidence: 99%

Section: Article Reviewsmentioning

confidence: 99%

Section: Article Reviewsmentioning

confidence: 99%

Section: Article Reviewsmentioning

confidence: 99%

Section: Article Reviewsmentioning

confidence: 99%

See 3 more Smart Citations

Inflicted Traumatic Brain Injury: Advances in Evaluation and Collaborative Diagnosis

Glick

Staley²

2007

Pediatr Neurosurg

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Retino‐Dural Hemorrhage of Infancy

Squier

2013

Wiley Encyclopedia of Forensic Science

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The term shaken baby syndrome (SBS), defined by the triad of retinal hemorrhage (RH), encephalopathy, and subdural hemorrhage (SDH), despite being widely accepted for 40 years, can no longer be regarded as a valid diagnosis. Multiple lines of evidence, from biomechanics to advances in understanding the anatomy and pathophysiology of the developing infant brain and its coverings, have undermined the diagnosis, and the nomenclature has been revised to reflect this. It is important to shift the focus to the objective pathological findings in babies with these closely interrelated phenomena rather than speculating on mechanisms; the term retino‐dural haemorrhage of infancy more accurately characterizes this syndrome. RHs have many causes and are more common after natural disease and accidents than after inflicted injury. Encephalopathy results from hypoxic‐ischemic injury rather than from traumatic axonal injury. Trauma is a cause of infant SDH, but there are many natural causes; almost half of normal newborns have SDH identified on brain scan. Infant SDH is usually a thin bilateral film, its source traditionally ascribed to torn bridging veins, but this remains unproved and is rarely documented. The dura is an alternative source; the infant dura is richly vascularized and innervated and bleeding into it is common. SDH evolves into a reactive membrane containing thin‐walled capillaries. Recurrent bleeding into these membranes is seen on microscopy. In some cases, SDH evolves into a chronic fluid collection; the causes for this are unknown. Biomechanical studies have shown that the forces generated by shaking are far less than those resulting from impact, but it remains correct to advise parents that babies should never be shaken. This article examines the pathology of each of these signs and their pathophysiology. The importance of considering the birth, early clinical history, and predisposing vulnerabilities when examining a case of suspected abuse is emphasized.

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26 cm fall caught on video causing subdural hemorrhages and extensive retinal hemorrhages in an 8‐month‐old infant

Brook,

Squier,

Mack

2024

Clinical Case Reports

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Key Clinical MessageSevere, too many to count retinal hemorrhages (RH) in infants have been associated with abusive head trauma, but can occur in short falls. An 8‐month‐old male fell backward from a height of 26 cm, landing on his buttocks then hitting the back of his head on a vinyl floor. The fall was videotaped. Acute subdural hemorrhages were found along with extensive, too many to count intra‐RH in both eyes. Falls from small heights on to the occiput can lead to extensive RH of the type often associated with abusive head trauma.

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A Witnessed Short Fall Mimicking Presumed Shaken Baby Syndrome (Inflicted Childhood Neurotrauma)

Abstract: A witnessed fall backwards of an infant from a sitting position resulted in the subdural hematoma and retinal hemorrhages characteristic of presumed shaken baby syndrome. Violent shaking is not necessary to produce these findings.

Cited by 26 publications

References 11 publications

Inflicted Traumatic Brain Injury: Advances in Evaluation and Collaborative Diagnosis

Inflicted Traumatic Brain Injury: Advances in Evaluation and Collaborative Diagnosis

Retino‐Dural Hemorrhage of Infancy

26 cm fall caught on video causing subdural hemorrhages and extensive retinal hemorrhages in an 8‐month‐old infant

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