eMedicine Specialties > Neurology > Pediatric Neurology
Neonatal Injuries in Child Abuse: Differential Diagnoses & Workup
Updated: Mar 18, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Blood Dyscrasias and Stroke | Subdural Empyema |
| Cerebellar Hemorrhage | Subdural Hematoma |
| Epidural Hematoma | |
| Head Injury | |
| Intracranial Hemorrhage |
Other Problems to Be Considered
Accidental trauma (eg, subdural hematoma, especially in children with enlarged extra-axial spaces)
Arteriovenous malformation
Bleeding disorders
Connective tissue disorder (ie, osteogenesis imperfecta)
Infectious subdural effusion
Metabolic disorders, especially glutaric aciduria type 1 (can cause retinal hemorrhages and intracranial lesions)
Workup
Laboratory Studies
Laboratory studies for shaken baby syndrome are nonspecific and are not diagnostic.
- Leukocytosis is seen in approximately 50% of patients.
- Serum chemistry findings are usually normal, but they may reveal evidence of acidosis.
- The cerebrospinal fluid may be bloody, possibly indicating subarachnoid hemorrhage.
Imaging Studies
- The true nature of the problem is often discovered only after CT is performed and evidence of intracranial pathology is found.
- The key to diagnosing shaken baby syndrome is neuroimaging.
- CT scanning of the brain is sufficient to diagnose subdural hemorrhage (see Media file 1), cerebral edema (see Media file 2), and/or subarachnoid hemorrhage. CT is usually the first neuroimaging study obtained in the ED.
CT scan shows a subdural hematoma.
CT scan shows cerebral edema with loss of gray matter–white matter distinction.
- As a follow-up study, MRI can be used to determine the extent of the neurologic injury (see Media files 3-6). MRI may be helpful for continued management and prognosis.
T1-weighted MRIs reveal bilateral chronic subdural hematomas as well as severe encephalomalacia involving the parietal, occipital, and temporal lobes.
T1-weighted MRIs show chronic bilateral subdural hematomas.
T2-weighted MRIs show encephalomalacia after shaken baby syndrome.
Sagittal MRIs show chronic subdural hematoma.
- Retinal hemorrhages can be seen as early as 48 hours before any intracranial lesions can be detected on brain CT or MRI.
- CT scanning of the brain is sufficient to diagnose subdural hemorrhage (see Media file 1), cerebral edema (see Media file 2), and/or subarachnoid hemorrhage. CT is usually the first neuroimaging study obtained in the ED.
- As long as the fontanelle is still open, ultrasonography can be performed to identify an intracranial hemorrhage. However, a negative head sonogram does not rule out intracranial pathology.
Other Tests
- An ophthalmologic evaluation is extremely important and helpful in diagnosis.
- A dilated eye examination is preferred. However, in the ED, all patients (regardless of the presenting complaint) should receive retinal examination with a direct ophthalmoscope.
- Papilledema indicates increased intracranial pressure, and retinal hemorrhage strongly suggests shaken baby syndrome (see Media file 7).
Funduscopic image shows intraretinal hemorrhages, subhyaloid hemorrhages, localized hemorrhagic choroid detachments, and thin retinal folds.
- All patients in whom abuse is suspected must be given a long-bone skeletal survey to check for new or healing fractures, which help in the diagnosis.
More on Neonatal Injuries in Child Abuse |
| Overview: Neonatal Injuries in Child Abuse |
 Differential Diagnoses & Workup: Neonatal Injuries in Child Abuse |
| Treatment & Medication: Neonatal Injuries in Child Abuse |
| Follow-up: Neonatal Injuries in Child Abuse |
| Multimedia: Neonatal Injuries in Child Abuse |
| References |
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References
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Further Reading
Keywords
shaken baby syndrome, shaken-baby syndrome, SBS, shaking, neurologic injury in child abuse, battered child syndrome, battered-child syndrome, child abuse, shaken infant, shaking impact syndrome, shaking-impact syndrome, retinal hemorrhage
