Two Infant Boys Misdiagnosed as “Shaken Baby” and Their Twin Sisters: A Cautionary Tale

Wester, Knut

doi:10.1016/j.pediatrneurol.2019.02.024

Cited by 14 publications

(32 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The male preponderance was evident even in the earliest publications on SDH, as was the age distribution with a peak incidence during the first 6 months of life . The similar gender distribution of BEH and SDH with a marked male preponderance has been noted before . In general, boys, presumably with larger heads than girls, have a higher risk of neonatal morbidity and mortality .…”

Section: Epidemiology Of Sdh and Behmentioning

confidence: 51%

“…12,16,35 A recent article describes the legal and social consequences of such diagnostic mistakes in detail. 36 SDH in infants without an acceptable history of trauma is likely to be associated with AHT/NAT (nonaccidental trauma, formerly known as shaken baby syndrome-SBS). However, without a valid scientific basis for assuming such a causal relation, 37 other possible causes and associations are important to explore.…”

Section: A Subdural Collection Containing Blood Elements In An Infantmentioning

confidence: 99%

“…43,55 The similar gender distribution of BEH and SDH with a marked male preponderance has been noted before. 36,56 In general, boys, presumably with larger heads than girls, have a higher risk of neonatal morbidity and mortality. 57 A large foetal head circumference in itself is associated with complicated labour.…”

Section: Epidemi Ology Of S Dh and B Ehmentioning

confidence: 99%

“…Several authors have pointed to the risk of a spontaneously occurring SDH in an infant with BEH being misdiagnosed as abusive head trauma (AHT) . A recent article describes the legal and social consequences of such diagnostic mistakes in detail …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Examining perinatal subdural haematoma as an aetiology of extra‐axial hygroma and chronic subdural haematoma

Zahl¹,

Wester

Gabaeff³

2019

Acta Paediatrica

Self Cite

View full text Add to dashboard Cite

Aim Benign external hydrocephalus (BEH), hygroma and chronic subdural haematoma are extra‐axial fluid collections in infants. MRI studies have shown that almost half of all new‐borns have perinatal subdural blood, generally referred to as subdural haematoma (SDH) or perinatal SDH. Epidemiologically there are striking similarities between chronic SDH and BEH in infants. Methods Discussion of pathophysiological mechanisms for BEH and chronic SDH, based on existing literature. Results Perinatal SDH is common, and we hypothesise that this condition in some infants develop into extra‐axial fluid collections, known as hygroma, BEH or chronic subdural haematoma. The mechanism seems to be an intradural bleeding that creates an obstructive layer preventing normal CSF absorption. The site where the bleeding originates from and those areas enveloped in blood from the primary damaged area are prone to later rebleeds, seen as ‘acute on chronic’ haematomas. With steady production of CSF and the blockage, increased intracranial pressure drives the accelerated skull growth seen in many of these children. Conclusion Perinatal SDH hampers CSF absorption, possibly leading to BEH and chronic SDH, with a high risk of false accusations of abuse. Close monitoring of head circumference could prove vital in detecting children with this condition.

show abstract

Section: Epidemiology Of Sdh and Behmentioning

confidence: 51%

Section: A Subdural Collection Containing Blood Elements In An Infantmentioning

confidence: 99%

Section: Epidemi Ology Of S Dh and B Ehmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Examining perinatal subdural haematoma as an aetiology of extra‐axial hygroma and chronic subdural haematoma

Zahl¹,

Wester

Gabaeff³

2019

Acta Paediatrica

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, Yamaoka et al do not question the possibility of overdiagnosis of abuse by failure to recognise natural conditions, such as Benign External Hydrocephalus (BEH). 4 BEH is an apparently congenital condition that may be, and may have been, misdiagnosed as abuse. It is subtype of hydrocephalus, characterised by a rapid increase of head circumference (HC) in infancy, enlarged subarachnoid spaces (especially frontally), and normal or enlarged ventricles.…”

mentioning

confidence: 99%

Do Inter-Country Differences in the Frequency of Abusive Head Trauma Reflect Different Proportions of Overdiagnosis of Abuse or True Differences in Abuse?

Högberg

Squier

Andersson

et al. 2020

Journal of Epidemiology

Self Cite

View full text Add to dashboard Cite

Neuroradiological findings in children with subdural hematoma and suspected abusive head trauma

Zahl

Andersson

Wester

et al. 2023

Annals of the Child Neurology Society

Self Cite

View full text Add to dashboard Cite

Aim Abusive head trauma (AHT) is often suspected in infants with subdural hematoma (SDH). Other neuroradiological findings have also been reported in assumed AHT, such as hypoxic–ischemic injury (HII), cortical vein thrombosis, and subarachnoid hemorrhage. The purpose of this study was to investigate neuroradiological and clinical findings in cases of suspected AHT. Methods Infants with SDH suspected to be caused by AHT, referred to the Swedish National Board of Forensic Medicine during the period 1994–2018, were considered for inclusion. Results Ninety‐six cases were included, with 68% males. The proportions of infants born prematurely, and twins, were higher than in the normal population. Signs of “benign enlargement of the subarachnoid space” (BESS) were found in 36% and were associated with chronic SDH and nonacute symptoms. HII was found in 16% and was associated with subarachnoid hemorrhage and high mortality, but not traumatic findings. Clinical signs of increased intracranial pressure were associated with retinal hemorrhages. Conclusion This analysis indicates that infants with SDH investigated for AHT are a heterogeneous group with some cases associated with external signs of trauma and others with possibly nontraumatic etiologies. Infants with BESS are more likely to have chronic SDH and nonacute symptoms. Patients with HII often have serious/fatal outcomes, but are not associated with external signs of injury. The overrepresentation of males, premature infants, and twins is unexplained.

show abstract

Two Infant Boys Misdiagnosed as “Shaken Baby” and Their Twin Sisters: A Cautionary Tale

Cited by 14 publications

References 80 publications

Examining perinatal subdural haematoma as an aetiology of extra‐axial hygroma and chronic subdural haematoma

Examining perinatal subdural haematoma as an aetiology of extra‐axial hygroma and chronic subdural haematoma

Do Inter-Country Differences in the Frequency of Abusive Head Trauma Reflect Different Proportions of Overdiagnosis of Abuse or True Differences in Abuse?

Neuroradiological findings in children with subdural hematoma and suspected abusive head trauma

Contact Info

Product

Resources

About