Position Paper on Fatal Abusive Head Injuries in Infants and Young Children

Abstract

This article represents the work of the National Association of Medical Examiners Ad Hoc Committee on shaken baby syndrome. Abusive head injuries include injuries caused by shaking as well as impact to the head, either by directly striking the head or by causing the head to strike another object or surface. Because of anatomic and developmental differences in the brain and skull of the young child, the mechanisms and types of injuries that affect the head differ from those that affect the older child or adult. The mechanism of injury produced by inflicted head injuries in these children is most often rotational movement of the brain within the cranial cavity. Rotational movement of the brain damages the nervous system by creating shearing forces, which cause diffuse axonal injury with disruption of axons and tearing of bridging veins, which causes subdural and subarachnoid hemorrhages, and is very commonly associated with retinal schisis and hemorrhages. Recognition of this mechanism of injury may be helpful in severe acute rotational brain injuries because it facilitates understanding of such clinical features as the decrease in the level of consciousness and respiratory distress seen in these injured children. The pathologic findings of subdural hemorrhage, subarachnoid hemorrhage, and retinal hemorrhages are offered as "markers" to assist in the recognition of the presence of shearing brain injury in young children.

Diffusion Tensor Imaging Reliably Detects Experimental Traumatic Axonal Injury and Indicates Approximate Time of Injury

“…Using DTI as a biomarker for axonal injury could markedly improve the efficiency of such trials. In a forensic investigation, the approximate age of a pericontusional traumatic white matter lesion could be assessed to either confirm or call into question the reports of witnesses or other evidence (Case et al, 2001;Oehmichen et al, 2003). A growing body of forensic imaging literature supports this possibility (Kahana and Hiss, 1999;Thali et al, 2007).…”

Factors Associated with Hemispheric Hypodensity after Subdural Hematoma following Abusive Head Trauma in Children

“…It is known that SDH is commonly observed in sTBI secondary to AHT, [27][28][29] and therefore children suffering from AHT comprised a natural population for study. Herein, we found that neurologic exam and most radiographic hallmarks do not seem to predict HH.…”

Shaken baby syndrome

“…The loss of blood, typically 2-15 ml, into the subdural space is not of itself harmful. 7 It provides firm evidence of shaking in the absence of a history of severe accidental head trauma.…”