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In 1971 Dr Norman Guthkelch hypothesised a causal link between shaking infants, a relatively common practice in the UK at the time, and findings of retinal and subdural haemorrhage with no or minimal of trauma (see Chapter 2). The link between shaking and a ‘triad’ of retino-dural haemorrhage and encephalopathy would come to be known as shaken baby syndrome (SBS). This book has taken a broad overview and analysis of the state of SBS, addressing global medical, scientific, social, and legal aspects of the determination.
This chapter focuses on the correlation of radiologic imaging with pathologic findings in infants and children with brain insults. Imaging is usually obtained while the child is alive, often shortly after a change in mental status. The imaging studies can therefore serve as a powerful tool to diagnose alterations of the macroscopic anatomy contributing to brain dysfunction. It is often not the anatomic abnormalities seen on imaging that are disagreed upon in cases of suspected shaken baby syndrome (SBS) or abusive head trauma (AHT); instead, the disagreements centre around what conclusions can be drawn from the anatomic alterations that have been identified. This chapter explores the strengths and weaknesses of radiologic imaging in the context of suspected AHT and emphasises the importance of understanding the pathologic basis of diagnoses made on imaging studies.
Shaken baby syndrome (SBS), in its many guises (abusive head trauma, non-accidental injury, etc.) has been widely accepted and taught among paediatricians for more than 50 years. The central tenet of the hypothesis is that shaking can cause any or all of subdural haemorrhage (SDH), retinal haemorrhage (RH), and encephalopathy. These same pathologies are seen in normal newborn babies and infants after a range of insults, including trauma, and reflect the immature anatomy and pathophysiology of the infant brain and its covering membranes. Spinal damage is increasingly invoked to support the shaking diagnosis. This chapter examines the various brain, eye, and spinal pathologies claimed to be due to shaking, setting them in the context of the anatomy and specific vulnerabilities of the infant. We evaluate the empirical evidence that neuropathology can provide to support or refute these claims.
Since the early 2000s, a growing body of scientific studies in neuropathology, neurology, neurosurgery, biomechanics, statistics, criminology and psychology has cast doubt on the forensic reliability of medical determinations of Shaken Baby Syndrome (SBS), more recently termed Abusive Head Trauma (AHT). Studies have increasingly documented that accidental short falls and a wide range of medical conditions, can cause the same symptoms and findings associated with this syndrome. Nevertheless, inaccurate diagnoses, unrealistic confidence expression, and wrongful convictions continue to this day. Bringing together contributions from a multidisciplinary expert panel of 32 professionals across 8 countries in 16 different specialties, this landmark book tackles the highly controversial topic of SBS, which lies at the intersection of medicine, science, and law. With comprehensive coverage across multiple disciplines, it explains the scientific evidence challenging SBS and advances efforts to evaluate how deaths and serious brain injuries in infants should be analysed and investigated.
Wilson disease should be considered as a possible diagnosis in any child who presents with liver disease particularly if it is sub acute or chronic. The pathogenesis of Wilson disease is an inability to excrete copper via the bile. Studies with radioactive copper have shown that in the early, presymptomatic stage, the liver takes up the metal avidly. Treatment is conventional as for other forms of epilepsy, but treatment of Wilson disease must be vigorously pursued with penicillamine or trientine. Magnetic resonance imaging (MRI) brain scans may show lesions in the basal ganglia, most commonly the putamen, also widening of the cerebral ventricles and cortical atrophy. Wilson disease is best managed at a specialist clinic. The prognosis for most patients with Wilson disease is excellent but the degree of recovery of the neurological deficit inevitably depends upon the amount of damage to the brain before treatment is started.