A baby was vigorously shaken by parents. What do you expect in the baby?
d. Sub-dural hematoma(Ref: Nelson's 20/e p 239-243, 3067)Child abuse/Shaken baby syndrome/lnflicted childhood neurotraumaIt occurs secondary to violent, non-accidental, repetitive, unrestrained acceleration-deceleration head & neck movements, with or without blunt head trauma in children typically <3 year of age.Inflicted childhood neurotrauma accounts for 10% of all cases of child abuse and carries a mortality rate of up to 25%.Retinal hemorrhage (multiple, involving >1 layer) is the most common ophthalmic finding.Fractures that strongly suggest abuse include classic metaphyseal corner lesions, posterior/1st rib fracture, scapular/sternal fracture, spinous process fracture. These fractures require more force than would be expected from a minor fall or routine handling and activities of a child.Abusive head trauma (AHT) results in the most significant morbidity and mortality & may be caused by direct impact, asphyxia, or shaking.Subdural hematomas, retinal hemorrhages & diffuse axonal injury strongly suggest AHT, especially when they co-occur.
Rib fractures
Pelvic fracture
Ruptured spleen
Sub-dural hematoma
Musculo Skeletal Disorders