High-resolution cranial ultrasound in the shaken-baby syndrome

Abstract

With limited near-field resolution and accessible acoustic windows, sonography has not been advocated for assessing central nervous system injuries in the shaken-baby syndrome. Our purpose was to correlate high-resolution ultrasonographic characteristics of central nervous system injuries in whiplash injuries and the shaken-baby-syndrome with MRI and CT. Ultrasonographic images of 13 infants, aged 2-12 months, with whiplash or shaking cranial trauma were reviewed and compared with MRI in 10 and CT in 10. Five patients had serial ultrasonography and MRI or CT follow-up from 1 to 4 months after the initial injury. With ultrasonography we identified 20 subdural haematomas. MRI and CT in 15 of these showed that four were hyperechoic in the acute stage, three were mildly echogenic in the subacute stage, and that one subacute and seven chronic lesions were echo-free. Five patients had acute focal or diffuse echogenic cortical oedema which evolved into subacute subcortical hyperechoic haemorrhage in four, and well-defined chronic sonolucent cystic or noncystic encephalomalacia was seen at follow-up in two. Using ultrasonography we were unable to detect two posterior cranial fossa subdural haematomas or subarachnoid haemorrhage in the basal cisterns in three cases, but did show blood in the interhemispheric cistern and convexity sulci in two. U1-trasonography has limitations in demonstrating abnormalities remote from the high cerebral convexities but may be a useful adjunct to CT and MRI in monitoring the progression of central nervous system injuries in infants receiving intensive care.

Insufficient evidence for ‘shaken baby syndrome’ – a systematic review

“…Of these, 1034 did not fulfil the inclusion criteria and were subsequently excluded, resulting in 30 included papers. Of these, 28 were assessed as having a high risk of bias , two as having a moderate risk and none as having a low risk (Fig. ).…”

Recent Research and Views on Shaking Baby Syndrome

“…There appears to be no way of being absolutely certain of the cause of an injury. Sometimes whiplash injuries are cited as the reason for the damage caused to the child [19]. Other non-intentional damage can be due to forceful bouncing of the child in a baby rocker as noted by de San Lazaro and Ogden [20].…”

From the Archives of the AFIP

“…A thickened inner membrane may be seen; this finding is regarded as a useful sign of an abnormal subdural space. Limitations of US include its relatively poor depiction of the posterior fossa and far convexities and its inability to demonstrate the nature of abnormal fluid collections (SDH or effusion associated with meningitis) (139). Its greatest utility at the present time is as a convenient method of following an abnormality previously documented at CT or MR imaging.…”