Infantile Subdural Haematoma and its Relationship to Whiplash Injuries

Abstract

SummarySubdural haematoma is one of the commonest features of the battered child syndrome; yet by no means all the patients so affected have external marks of injury on the head. This suggests that in some cases repeated acceleration/deceleration rather than direct violence is the cause of the haemorrhage, the infant having been shaken rather than struck by its parent. Such an hypothesis might also explain the remarkable frequency of the finding of subdural haemorrhage in battered children as compared with its incidence in head injuries of other origin, and the fact that it is so often bilateral.

Vitreoretinal traction is a major factor in causing the haemorrhagic retinopathy of abusive head injury? – No

“…5,6 Guthkelch, a British neurosurgeon, first postulated that the cause of SDH in Battered Child Syndrome was a shaking injury, causing rotational forces within the cranium which disrupted vessels bridging the subdural space. 7 He commented that, at the time, a 'good shaking' was considered by many British parents socially more acceptable and less dangerous than a blow to the head.…”

Shaken Baby Syndrome: An Odyssey

“…9) Holbourn understood that the deformable brain was incompressible, hypothesized a rotational acceleration level beyond which injury would occur, and that a smaller mass of brain would require larger rotational acceleration. Ommaya himself alluded to this point in his paper, 16) although this seems not to have been recognized by Guthkelch,8) Caffey, 2,3) and others. In 1987 Duhaime et al, 7) using available data on scaled injury thresholds, demonstrated that shaking a mechanical model to cause intracranial injury in the form of concussion, subdural hematoma, and diffuse axonal injury, failed to reach such Shaken Baby Syndrome: An Odyssey thresholds.…”

“…Ommaya found intracranial injury in 18 of the animals, with concomitant neck injury in 11 of the 18. The purely isolated concept of rotational acceleration of sufficient magnitude to cause intracranial injury without impact and therefore without external evidence of injury was seized upon qualitatively by Guthkelch,8) Caffey,2,3) and others as the explanation for hitherto unexplained intracranial injury in infants. This concept was hypothesized and put forth by them as being the result of manual shaking.…”

“…He never addressed the question as to whether human beings can shake infants with enough force to produce the acceleration necessary to cause intracranial injury. It is also significant that neither Guthkelch,8) Caffey, 2,3) nor any subsequent investigators who have sought to identify and characterize ostensible shaking injuries to the infant head ever asked whether the infant torso and neck anatomy, quite different physiologically from that of the rhesus monkey and of the``non-infant'' human, could withstand such shaking. Nonetheless, the mechanism of shaking and the so named syndrome gained immediate acceptance and enormously widespread popularity, with no real investigation or even question as to its scientific validity.…”

Medicolegal Approach to Child Physical Abuse in an Emergency Clinic

“…In 1962, Henry Kempe described the clinical signs of physical abuse of children and was the first to present the "battered child syndrome" concept (3). Shaken infant syndrome was first described by Guthkelch and then by Caffey in the beginning of 1970s (4,5). The pioneering work of these doctors marked the major milestones for the detection of child abuse cases, and they raised awareness on this issue.…”