Definition: head trauma through strong rotational and shearing force

Epidemiology

high mortality and a significant cause of death

Etiology

violent shaking of a child

Pathophysiology

• Rotational and shearing forces → shearing off of bridging veins → subdural hematoma
• Shaking of the child with a weak neck support → respiratory problems and apnea → hypoxia → brain edema and ischemia → diffuse axonal damage

Clinical features

• Inconsistent or implausible history from caretakers
• Injuries are hardly evident or entirely absent on physical exam.
• Retinal hemorrhages
• Irritability or lethargy
• Seizures
• Vomiting
• Tense fontanelle
• Rib fractures

Diagnostics

• Non-contrast CT
  • Subdural hematomas and/or subarachnoid hemorrhage of varying ages
  • Reversal sign: diffuse blurring of the grey-white matter interface
  • Diffuse punctate hemorrhages

Treatment

• Always notify Child Protective Services.
  • Medical practitioners are obligated to report child abuse even if that means breaking patient-physician confidentiality.
  • Reasonable suspicion is sufficient; confirmation of abuse or neglect is not required for reporting purposes.
• Interview child and parent/caregiver separately if possible.
• Keep verbatim record.