Patterns of presentation of the shaken baby syndrome: Four types of inflicted brain injury predominate

doi:10.1136/bmj.328.7442.766

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Robert A Minns, consultant paediatric neurologist (Robert.Minns@ed.ac.uk)1,
Anthony Busuttil, professor of forensic medicine2

¹Child Life and Health, University of Edinburgh and Royal Hospital for Sick Children, Edinburgh EH9 1LF
²Forensic Medicine Unit, University of Edinburgh, Edinburgh EH8 9AG

EDITOR—One of the controversies that has recently arisen in cases of alleged shaken baby syndrome concerns the disparity between certain neuropathological findings at necropsy and whether these findings are consistent with the entity regarded as the shaken baby syndrome.

A database was collected for more than five years of documented Scottish cases of suspected non-accidental head injury diagnosed after a multiagency assessment and including cases with uncoerced confessions of perpetrators and criminal convictions. Several patterns of presentation allow delineation of cases into four predominant types.

Hyperacute encephalopathy (cervicomedullary syndrome)

This hyperacute encephalopathy (6% of all cases) results from extreme “whiplashing” forces, the infant suffering the equivalent of a broken neck or, more correctly, a broken brain stem. In infants with a median survival of one day Geddes et al described localised axonal damage at the craniocervical junction, in the corticospinal tracts, and in the cervical cord roots, consistent with hyperflexion and hyperextension movements.1 These cases, which truly reflect a “whiplash” shaking injury to …