Neuropathological changes in a lamb model of non-accidental head injury (the shaken baby syndrome)

Finnie, John; Blumbergs, Peter; Manavis, Jim; Turner, Renée J.; Helps, Stephen C.; Vink, Robert; Byard, Roger W.; Chidlow, Glyn; Sandoz, Baptiste; Dutschke, Jeffrey; Anderson, Robert

doi:10.1016/j.jocn.2011.12.019

Cited by 64 publications

(39 citation statements)

References 18 publications

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“…The percentages of AI reported in our study were based on total brain volume, and when we express them as a fraction of the white matter (approximately 19% of total cerebrum), we estimate 0.07% of the white matter of our 6 h sagittal cyclic head rotations had injury, which is three orders of magnitude lower than the Finnie studies. 26,65 It is challenging to interpret these similarities and differences, however, because no angular kinematic measurements of the lamb head rotations were reported, 25 and it is unclear how the mechanical forces applied to the lambs compared with that of the pigs in this study. The lamb's neck is also longer than that of the pig, and the head movement was not constrained, so we speculate that hyperflexion and hyperextension of the lamb's neck may have occurred.…”

Section: Discussionmentioning

confidence: 86%

“…25,26 The shakes caused full head excursion with considerable lateral and rotational head movement and resulted in AI, very mild focal subdural hemorrhages (three of nine lambs), but no retinal hemorrhages at 6 h postshaking. 26 Sheep brains are classified as pre-natal brain developers, and their brains are relatively mature at birth (72% of adult cerebrum weight and 50% myelination as determined by cerebrum lipid content). 27 In humans, the brain is approximately 28% of adult brain weight at birth and has only 34% of adult myelination (also determined by cerebrum lipid content).…”

Section: Introductionmentioning

confidence: 99%

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Cyclic Head Rotations Produce Modest Brain Injury in Infant Piglets

Coats

Binenbaum

Smith

et al. 2017

Journal of Neurotrauma

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Repetitive back-and-forth head rotation from vigorous shaking is purported to be a central mechanism responsible for diffuse white matter injury, subdural hemorrhage, and retinal hemorrhage in some cases of abusive head trauma (AHT) in young children. Although animal studies have identified mechanisms of traumatic brain injury (TBI) associated with single rapid head acceleration-decelerations at levels experienced in a motor vehicle crash, few experimental studies have investigated TBI from repetitive head rotations. The objective of this study was to systematically investigate the postinjury pathological time-course after cyclic, low-velocity head rotations in the piglet and compare them with single head rotations. Injury metrics were the occurrence and extent of axonal injury (AI), extra-axial hemorrhage (EAH), red cell neuronal/axonal change (RCNAC), and ocular injury (OI). Hyperflexion/extension of the neck were purposefully avoided in the study, resulting in unscaled angular accelerations at the lower end of reported infant surrogate shaking kinematics. All findings were at the mild end of the injury spectrum, with no significant findings at 6 h post-injury. Cyclic head rotations, however, produced modest AI that significantly increased with time post-injury ( p < 0.035) and had significantly greater amounts of RCNAC and EAH than noncyclic head rotations after 24 h post-injury ( p < 0.05). No OI was observed. Future studies should investigate the contributions of additional physiological and mechanical features associated with AHT (e.g., hyperflexion/extension, increased intracranial pressure from crying or thoracic compression, and more than two cyclic episodes) to enhance our understanding of the causality between proposed mechanistic factors and AHT in infants.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Cyclic Head Rotations Produce Modest Brain Injury in Infant Piglets

Coats

Binenbaum

Smith

et al. 2017

Journal of Neurotrauma

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“…Spontaneous resorption of the subdural hemorrhage occurs in most cases. 2 Retinal hemorrhage is another cardinal manifestation of nonaccidental trauma in children. It is caused by vitreoretinal traction from repetitive acceleration-deceleration forces.…”

Section: Discussionmentioning

confidence: 99%

New-Onset Seizures in an Infant

Agrawal¹,

Dokania²,

Severin³

2015

Pediatr Ann

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“…[16][17][18] Although the exact etiological mechanisms that cause injury in children with AHT remain controversial, repetitive motions attempting to model aspects of shaking have been employed in some animal models to investigate injury, but none has resulted in the extensive SDH nor the widespread hypoxic-ischemic type damage observed after the more severe forms of AHT in children. [19][20][21] Here we present a unique, immature, large-animal model designed to replicate the constellation of injuries and insults typical in AHT-associated patterns of predominantly unilateral hypodensity with patterns of tissue damage seen in children. We used our wellcharacterized cortical impact model to induce mechanical trauma, as children with HH often have evidence of blunt mechanical trauma of some type.…”

Section: Introductionmentioning

confidence: 99%

Development of a Model of Hemispheric Hypodensity (“Big Black Brain”)

Costine-Bartell

McGuone

Price

et al. 2019

Journal of Neurotrauma

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Subdural hematoma (SDH) is the most common finding after abusive head trauma (AHT). Hemispheric hypodensity (HH) is a radiological indicator of severe brain damage that encompasses multiple vascular territories, and may develop in the hemisphere(s) underlying the SDH. In some instances where the SDH is predominantly unilateral, the widespread damage is unilateral underlying the SDH. To date, no animal model has successfully replicated this pattern of injury. We combined escalating severities of the injuries and insults commonly associated with HH including SDH, impact, mass effect, seizures, apnea, and hypoventilation to create an experimental model of HH in piglets aged 1 week (comparable to human infants) to 1 month (comparable to human toddlers). Unilateral HH evolved over 24 h when kainic acid was applied ipsilateral to the SDH to induce seizures. Pathological examination revealed a hypoxic-ischemic injury-type pattern with vasogenic edema through much of the cortical ribbon with relative sparing of deep gray matter. The percentage of the hemisphere that was damaged was greater on the ipsilateral versus contralateral side and was positively correlated with SDH area and estimated seizure duration. Further studies are needed to parse out the pathophysiology of this injury and to determine if multiple injuries and insults act synergistically to induce a metabolic mismatch or if the mechanism of trauma induces severe seizures that drive this distinctive pattern of injury.

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Neuropathological changes in a lamb model of non-accidental head injury (the shaken baby syndrome)

Cited by 64 publications

References 18 publications

Cyclic Head Rotations Produce Modest Brain Injury in Infant Piglets

Cyclic Head Rotations Produce Modest Brain Injury in Infant Piglets

New-Onset Seizures in an Infant

Development of a Model of Hemispheric Hypodensity (“Big Black Brain”)

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