CASE HISTORY – June 2007

When should one think about inflicted brain injury: a literature overview and a case report.


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Inflicted brain injury or shaken baby syndrome is one of the major causes of mortality and morbidity in paediatric population. Estimation of the incidence of this particular form of child abuse is difficult as not all children are admitted to hospital. The incidence of SBS in different studies has varied from 21/100 000 in Scotland (3) to 29.7/ 100 000 in North Carolina (4). In a prospective population-based study carried out in paediatric units in Scotland during 1998 shaken impact syndrome was established with an annual incidence of 24.6 per 100 000 children younger than 1 year. In Estonia the incidence is 40.5 per 100 000 children under 1 year of age.  We describe a 3-month-old boy admitted to our hospital due to subdural haemorrhage. The history revealed that the child has been investigated with suspected trauma 3 weeks earlier. X-ray was done but as the methaphyseal fracture of the left femur was misdiagnosed, it was not reported. MRI investigation showed two subdural haematomas possibly inflicted on different occasions with a 1-week intervals. Conservative treatment was prescribed.
We encourage all medical personnel to be very careful not to miss possible child abuse cases.