NEUROLOGICAL MANIFESTATIONS IN ABUSED CHILDREN WHO HAVE BÉEN SHAKEN

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Abstract
Four infants with the shaken infant syndrome are described. None had skull fractures; only 1 had subdural hemnatoma. All had extensive retinal and pre-retinal hemorrhages. Follow-up computerized tomography showed severe brainatrophy, multiple hypodense areas and ventricular enlargement. The patients(3) suffered severe, permanent brain damage, with mental retardation, spasticity and blindness. It is suggested that the underlying pathogenesis of this syndrome is acutely increased intrathoracic pressure, transmitted into the head to cause multiple venous infarctions. Retinal and pre-retinal hemorrhages are cardinal features of this syndrome and their presence should raise the suspicion of this form of battering in the absence of the classical signs of battering.