What is the pathophysiology of abusive head trauma in children?

Updated: Apr 24, 2017
  • Author: Angelo P Giardino, MD, MPH, PhD; Chief Editor: Caroly Pataki, MD  more...
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Discussing CNS injury and physical abuse inevitably leads to a discussion of abusive head trauma (AHT), previously referred to as shaken baby syndrome (SBS) or shaking-impact syndrome. [13] The original description of AHT (originally referred to as whiplash syndrome) describes a clinical constellation of findings classically described as subdural hematoma, retinal hemorrhage (found in 65-95% of cases), and skeletal fractures, such as metaphyseal fractures and posterior rib fractures (found in 30-70% of cases) sustained when the child is shaken violently back and forth. AHT represents a significant injury pattern in the realm of child maltreatment; although it is associated with the findings listed above, the core injury is to the brain cells themselves, resulting from the application of forces to the child's delicate and developing brain tissue.

AHT has been extended to include cases where the child's head is impacted against a surface, either soft or hard, and may be called AHT. Diffuse, serious brain injuries result from external forces that cause the rotation of the brain about its center of gravity. Such forces exceed those generated in normal childcare activities and are different from the low velocity translational forces (straight-line movement) that commonly occur in household falls. Immense angular deceleration forces may be generated with sudden striking of the child's head against a surface; these forces act on the brain tissue and cerebral vessels and generate the deleterious effect, which is not specifically from the contact forces applied to the skull.

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