Shaken baby syndrome without intracranial hemorrhage on initial computed tomography.
OBJECTIVE
We sought to describe the unique characteristics of children diagnosed with shaken baby syndrome (SBS) despite the absence of intracranial hemorrhage on cranial computerized tomography (CT) on hospital admission.


METHODS
Using an international e-mail-based listserv for professionals with an interest in child abuse, we identified and reviewed the charts of children hospitalized in different medical centers who were diagnosed with SBS although CT disclosed no signs of intracranial bleeding. Children with normal imaging were not included.


RESULTS
Eight cases were identified. All children had cerebral edema in CT, which was severe on 7/8 cases (88%). All of these children had extensive retinal hemorrhage. The prognosis was poor; 5/8 infants died (63% mortality), and the rest had permanent neurologic damage.


CONCLUSIONS
The diagnosis of SBS can be established even when CT at presentation does not demonstrate intracranial hemorrhage. We hypothesize that rapidly developing cerebral edema may cause increased intracranial pressure and tamponade that prevents the accumulation of intracranial blood. The prognosis in these cases is grave.
Morad
Yair
Y
Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel.
Avni
Isaac
I
Capra
Louise
L
Case
Mary E
ME
Feldman
Kenneth
K
Kodsi
Sylvia R
SR
Esernio-Jenssen
Debra
D
Lukefahr
James L
JL
Levin
Alex V
AV
D001929:Brain Edema / Q000000981:diagnostic imaging; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging*; D008297:Male; D011379:Prognosis; D012166:Retinal Hemorrhage / Q000175:diagnosis; D038642:Shaken Baby Syndrome / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed