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Findings in older children with abusive head injury: does shaken-child syndrome exist?
[child syndrome]
Shaken-baby
syndrome
(
SBS
)
has
been
hypothesized
to
occur
after
shaking
by
an
adult
during
the
first
2
years
of
life
.
We
wondered
whether
it
is
possible
to
achieve
rotational
forces
sufficient
to
cause
SBS-like
injuries
in
children
>
2
years
of
age
.
The
present
study
describes
cases
of
child
abuse
in
older
children
who
presented
with
the
classic
ophthalmologic
and
intracranial
findings
of
SBS
.
In
this
case
series
,
4
cases
of
older
children
(
2
.
5
-
7
years
old
;
11
.
8
-
22
kg
)
who
died
from
abusive
head
injuries
and
who
had
diffuse
retinal
hemorrhages
identified
antemortem
were
selected
for
review
.
The
cases
were
abstracted
from
hospital
charts
,
records
from
autopsies
,
coroners
'
and
district
attorneys
'
offices
,
and
court
transcripts
.
In
all
4
cases
the
history
provided
by
the
primary
caregiver
did
not
match
the
severity
of
the
injuries
.
Three
case
subjects
presented
with
patterned
bruises
.
Multilayered
retinal
hemorrhages
and
acute
subdural
hematoma
were
observed
in
all
4
cases
.
At
autopsy
,
diffuse
axonal
injury
was
evident
in
3
of
the
4
cases
;
all
4
cases
had
optic
nerve
sheath
hemorrhages
.
None
of
the
victims
had
skeletal
fractures
on
radiologic
examination
or
at
autopsy
.
This
case
series
demonstrates
that
it
is
possible
to
observe
SBS-like
retinal
and
central
nervous
system
findings
in
the
older
and
heavier
child
.
Our
findings
underscore
the
need
for
providers
to
consider
intentional
shaking
as
a
mechanism
of
injury
in
the
evaluation
of
abusive
head
injury
in
older
children
.
Diseases
Validation
Diseases presenting
"retinal hemorrhages"
symptom
child syndrome
coats disease
This symptom has already been validated