Nonaccidental Inflicted Neurotrauma Formerly Shaken Baby Syndrome

The true incidence of nonaccidental inflicted neurotrauma is unknown because of the difficulty collecting statistical data. An estimated 1300 children in the United States experience fatal head trauma from child abuse annually (JAMA, 2003). The findings of nonaccidental inflicted neurotrauma involve repetitive, violent, unrestrained, acceleration-deceleration, head and neck movements. Neurotrauma can occur without blunt head trauma. Cases primarily occur in children under 3 years old, usually during the first year of life. Typically, patients present with fracture and intracranial or intraocular hemorrhages; not all findings are required to establish the diagnosis. An ophthalmologic consult should be obtained for all patients with suspected nonaccidental inflicted neu-rotrauma, with carefully documented retinal drawings or preferably fundus photography. Approximately 20% of cases are fatal within the first few days of presentation. Traumatic retinoschisis, if present, is highly specific for nonaccidental inflicted neurotrauma, particularly if the child is younger than 5 years.

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