RADIOLOGICAL DIAGNOSTICS OF SHAKEN BABY SYNDROME

 

Medvedeva N.А.^1,2, Serova N.S.¹

 

1 – I.M. Sechenov First Moscow State Medical University (Sechenov University). Russia, Moscow.

2 – Bureau of Forensic Medicine of the Department of Health of the City of Moscow.

P

urpose. To identify the patterns of pathological changes in the central nervous system according to radiological diagnostics data for the syndrome of "shaking the child" on the example of a group of infants undergoing the procedure of forensic medical examination. To analyze the medical documentation (medical history and outpatient card of the child).

Materials and methods. In the period from 2014 to 2024, an analysis of medical histories, medical records and radiological methods was performed in children from 0 to 2 years old with a clinical diagnosis of "child shaking syndrome", who underwent a forensic medical examination procedure for traumatic brain injury at the state budgetary healthcare institution of the city of Moscow "Bureau of Forensic Medical Examination Department of Health of the city of Moscow.

Results. When analyzing radiological studies on electronic media, an interhemispheric localization of subdural hematoma (SDH) in 21 cases (n=21; 77%) was found, in 8 cases (n=8; 29%) – lamellar SDH localized convexitally. A combination of interhemispheric and convexital localization of ADHD was noted in 18 cases (n=18; 66%), and in 16 cases (n=16; 59%) SDCs were combined with subarachnoid hemorrhage (SAH). DAP was detected in 3 cases (n=3; 12%). In all 27 cases (n=27; 100%), radiological signs of cerebral edema were revealed, realized in a diffuse narrowing of the subarachnoid space, smoothness of gray-white differentiation and a gyral pattern.  All 27 injured children underwent an ophthalmological examination, according to the results of which hemorrhages in the fundus were diagnosed in 22 cases (n=22; 81%).

Discussion. Diagnosis of this condition is complicated by the fact that external traumatic changes on the face, head and soft tissues are not detailed, which does not correlate at all with the severe condition of the child. Given the high mortality rate in SBS, urgent and accurate diagnosis is the most important. Computed tomography (CT) and magnetic resonance imaging (MRI) have made a great contribution to the diagnosis of child shaking syndrome. According to research, in infant shaking syndrome, the triad of injuries includes shell hemorrhages and/or intracranial, cerebral edema and retinal hemorrhage. It was found that subdural hematomas with SBS have a relatively small size and are localized in the interhemispheric fissure or on the hyral surface of the brain, and are not associated with fractures of the skull bones.

Conclusion. When children from 0 to 2 years old who are admitted to the hospital in a severe somatic condition, which does not correspond to the data of the local status and external examination, it is necessary to use radiological diagnostic methods such as CT and MRI. If a hemispheric subdural hematoma and/or SAH are detected in combination with cerebral edema and retinal hemorrhages according to ophthalmological examination, it is necessary to clinically consider the diagnosis of SBS. Understanding the mechanisms of the pathogenesis of this syndrome is necessary for radiologists working with pediatric patients.

 

Keywords: shaking child syndrome, child abuse, forensic medical examination, traumatic brain injury in children, forensic medical examination in pediatrics.

 

Corresponding author: Medvedeva N.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Medvedeva N.А., Serova N.S. Radiological diagnostics of shaken baby syndrome. REJR 2024; 14(2):85-94. DOI: 10.21569/2222-7415-2024-14-2-85-94.

Received: 05.06.24 Accepted: 05.07.24