Non-accidental head injury and shaking baby syndrome. Clinical and pathophysiological aspects

Traumatic brain injury, in particular the shaken baby syndrome, leads to significant neurological disability in more than two-thirds of surviving victims and is fatal in 12-27% of cases. It is characterized by a constellation of subdural hematoma and mostly marked retinal hemorrhaging with severe diffuse brain injury, usually without external signs of injuries. Shaken baby syndrome resulting in significant brain damage requires extensive, violent shaking of a child leading to uncontrolled rotation of the head. The resulting subdural and retinal hemorrhages are, however, not important for the prognosis. The combination of diffuse axonal injury and initial traumatic apnea leading to hypoxia, ischemia and intracranial hypertension is assumed to be responsible for the marked brain damage. Clinical symptoms are irritability, feeding problems, somnolence, apathy, cerebral convulsions, vomiting, apnea, coma and death. Shaking injury is a syndromic diagnosis dependant on the total picture of clinical, ophthalmological, radiological and brain imaging features.