1/3. Pediatric spine and spinal cord injury after inflicted trauma.Pediatric spine and spinal cord injury are rare sequelae of intentional trauma. They may easily be overlooked, however, and probably represent an underreported phenomenon. Recent autopsy data analyzed in conjunction with prior case series indicate that injury to the upper cervical spine and brainstem may significantly contribute to the major morbidity, mortality, and neuropathology in shaken infants. The findings in the previous case report illustrate several important points regarding spine and spinal cord injury after intentional trauma. First, the very young are susceptible to severe, higher cervical injury of both spine and spinal cord. Second, spine and spinal cord injury were initially overlooked because of masked neurologic findings with the concomitant head injury and multiple other systemic injuries. Finally, the child's outcome with significant cognitive delay because of global brain injury in conjunction with the focal high cervical cord injury may support the hypothesis that hypoxic damage could have occurred secondary to brainstem and high cervical cord injury. At the authors' institution, a detailed history and vigilant physical examination are stressed. When the mechanism of injury reported in the history is incongruous with the physical or initial radiographic findings and intentional trauma is suspected, a full skeletal survey, ophthalmologic evaluation, and social evaluation is undertaken. MRI and CT scanning are individualized according to the clinical assessment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/3. shaken baby syndrome.A 5-month-old infant with shaken baby syndrome is reported. This form of physical child abuse is often overlooked. It should be suspected in infant who present with drowsiness, coma, seizures or apnea.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/3. shaken baby syndrome manifesting as chronic subdural hematoma: importance of single photon emission computed tomography for treatment indications--case report.A boy with shaken baby syndrome first presented at age 3 months with acute subdural hematoma (SDH) and was treated by subdural tapping at a local hospital. Chronic SDH was identified at a rehabilitation center at age 19 months. The chronic SDH appeared to have developed within the preceding 16 months. His physical and mental development was already delayed. Magnetic resonance (MR) imaging revealed a 20-mm thick right chronic SDH with midline shift and small bilateral subdural effusions. The chronic SDH had compressed the right cerebral hemisphere. MR imaging also disclosed bilateral cerebral atrophy. 99mTc-ethylcysteinate dimer single photon emission computed tomography (SPECT) revealed decreased cerebral blood flow (CBF) in the non-hematoma hemisphere, although CBF is said to decrease on the chronic SDH side, especially if midline shift is present. Burr hole craniotomy with external drainage was performed, but the patient showed no change in CBF postoperatively, although the volume of hematoma decreased. The patient was clinically unchanged immediately after the operation. In this case, SPECT measurement of CBF was important in evaluating the pathophysiology of the delays in physical and mental growth. atrophy of the bilateral hemispheres was the major mechanism in the decreased CBF, not the compression by chronic SDH. MR imaging and SPECT can determine the surgical indications for chronic SDH in patients with cortical atrophy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |