title: Shaken baby syndrome without intracranial hemorrhage on initial computed tomography.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Morad
authors.forename: Isaac
authors.initials: I
authors.lastname: Avni
authors.forename: Louise
authors.initials: L
authors.lastname: Capra
authors.forename: Mary E
authors.initials: ME
authors.lastname: Case
authors.forename: Kenneth
authors.initials: K
authors.lastname: Feldman
authors.forename: Sylvia R
authors.initials: SR
authors.lastname: Kodsi
authors.forename: Debra
authors.initials: D
authors.lastname: Esernio-Jenssen
authors.forename: James L
authors.initials: JL
authors.lastname: Lukefahr
authors.forename: Alex V
authors.initials: AV
authors.lastname: Levin
mesh_terms: 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