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The baby victim of a shock is not always diagnosed at the time of his first visit to the emergency room. The recommendation for good practice in situations of shaken baby syndrome, published in July 2017 by the French National Authority for Health, helps in the diagnosis and management of these infants by health care providers. When this diagnosis is made, the baby's care pathway is generally long and punctuated by multiple examinations., (Copyright © 2021. Published by Elsevier Masson SAS.)

In July 2017, the French National Authority for Health published a recommendation for good practice specific to shaken baby syndrome specifying the diagnostic approach, the mechanisms involved in shaking and the date of injury. This recommendation details the legal aspects in the case of a diagnosis of non-accidental head trauma, as well as the procedure to follow to report these situations. The High Authority for Health reaffirms this recommendation in December 2019, insisting on the importance of the role of carers in the identification, diagnosis and prevention of these situations., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Babies who suffer non-accidental head injuries systematically show sequels, whether they are neurological, cognitive or behavioural. Some of these disorders are immediately identified, such as neurological sequels, but others, such as cognitive or behavioural disorders, are revealed much later. Regular monitoring by a neuro-paediatrician is therefore essential in order to be able to adapt the child's care as closely as possible to his or her needs according to the sequels presented., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

The infant victim of shaken baby syndrome, also known as non-accidental head trauma, is, in some cases, admitted to a social nursery after hospitalisation, within the framework of a legal placement. Professionals are then in charge of accompanying him and his family, in order to lead them on the path of psychological and physical reconstruction., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Shaken baby syndrome (SBS) is defined by the association of intracranial hemorrhage and retinal hemorrhage in infants under 2 years of age, with no obvious external trauma. This syndrome leads to frequent neurological sequelae. Therefore, these infants can claim compensation for damage if sequelae are directly and irrefutably linked to the trauma. Data on the judicial treatment are for the most part inexistent in the medical literature, the reason for which this study was conducted., Population and Methods: We conducted a retrospective study over a period of 10 years. We included all cases of SBS reported to the High Courts of the Ille-et-Vilaine department (Rennes and St Malo). The cases were listed from the archives of the Department of Medical Information, the Specialized Unit for Abused Children and Forensic Department at the Rennes University Hospital. We were able to look the judicial cases up after receiving agreement from the prosecutors of the two courts., Results: Of the 34 cases included, 12 could not be used (lost, ongoing, destroyed, transferred to another court), 16 led to an order of dismissal or to no further action because of an unknown perpetrator, insufficiently described offense, or insufficient evidence. Six authors were sentenced. It was the father (n=5) or the childminder (n=1). All perpetrators had confessed to part or all of the charges brought against them. Five children received compensation: three by the civil court and two by the commission of compensation for victims of an offense., Conclusion: Most cases led to no conviction and no compensation. The identification by the physician of the person responsible for the lesions in SBS does not mean that the perpetrator will be convicted because of the strict application of criminal law. The nomination of an administrator representing the infant could resolve the lack of compensation., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Non-accidental brain trauma (also called shaken baby syndrome) represent the main cause for morbidity and mortality in the context of child abuse. It often occur in young infants aged less than 8months. The shaking leading to brain injuries are very violent and sometimes associated with a final impact. Intracranial injuries may be isolated without skeletal trauma or bruising. In any suspicion of such a diagnosis, emergency hospitalization is indicated. Brain CT, easy to perform in emergency, is the diagnostic key. It discloses diffuse subdural hematomas in typical sites as vertex, interhemispheric space and tentorium. There is no clear background of trauma and the related story is changing over time. The 3D analysis of the skull looks for signs of recent impact as a fracture that is sometimes complex and/or a soft tissue swelling of the scalp. Intraparenchymal injuries (contusions, tearing, and overall anoxic ischemic injuries) are better analyzed with MRI. The prognosis depends on their extent. Ophtalmologic examination is systematically performed looking for retinal hemorrhages (around one third of cases) which may be very subtle. Bruising is a major diagnostic sign, but inconstantly present. A precise datation of skeletal and/or brain injuries is not possible with imaging and the only indication of use is to establish the presence of "age different lesions". This indicates repeated trauma and thereby a high risk of recurrence., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Ocular traumas represent a major public health problem with poorly understood ramifications at both the individual and community levels. Any of the ocular structures can be damaged in the case of closed globe injury. These lesions, often multiple, may appear immediately or in a delayed fashion. Classifications have been developed recently in order to better inform the patient of the visual prognosis. However, significant efforts are still needed, on the one hand, to assess and develop new therapies, and on the other hand, to implement effective policies to prevent ocular trauma., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

We report on 2 cases associating retinal (RH) and cerebral hemorrhages (CH), which first suggested the diagnosis of shaken baby syndrome (SBS). After an etiologic search, the diagnosis was corrected: the first case was a late hemorrhagic disease of the newborn and the second case hemophilia A. RH is a major feature of SBS, although not pathognomonic. There is no specific RH of SBS but they usually affect the posterior retinal pole. Typically, RHs of SBS are present in both eyes, although unilateral RHs do not exclude the diagnosis of SBS. The relationship between RH and CH has been reported in SBS but also in other diseases. Thus, one must search for hemostasis abnormalities, even though the clinical presentation suggests SBS. Ignoring SBS as well as coming to the conclusion of SBS too quickly should be avoided. Diagnostic difficulties may be related to the number of physicians involved and their interpretation of the facts. These 2 cases underline the need for working as a team that includes hematologists able to interpret coagulation parameters., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Nearly all non accidental head injuries of children are shaken baby syndromes. The non accidental head trauma refers to a traumatic encephalopathy inflicted by an adult to a child. The syndrome combines subdural haematoma, retinal haemorrhages and absence of any external lesion. The mortality and morbidity rates of the SBS are high and the SBS is the main cause of death in hospitals handling child abuse. The incidence is not well-known and most probably underestimated. Numerous risk factors linked to the aggressor, to the victim and to the factual context have been identified. The diagnosis remains difficult to make, mainly due to the absence of reliable anamnesis in a majority of cases. It should be envisaged for all infants presenting unexplained acute encephalopathy. Imagery and ophthalmologic examination are the first examinations that are required to make such diagnosis. A cerebral RMI allowed for important progress both on the level of the diagnosis and the prognosis as well as on the level of the understanding of lesions. The physiopathogeny of this syndrome has considerably progressed in recent years which raise promising prospects for therapy. The treatment of babies with SBS requires highly competent teams including paediatric neurosurgeons but also teams specialised in child abuse which can quickly take care of the families. In view of the seriousness of the problem, several communication campaigns directed to young parents and the public have been organized recently in several countries among which Belgium.

Background and Purpose: MRI signal of a subdural hematoma (SDH) is often regarded as similar to that of an intracerebral hematoma but no precise study has analyzed the evolution of the signal of subdural hematomas. Their dating is however significant, in particular in the child, within the context of the diagnosis of child abuse. The objective of this study is to compare with MRI a group of adult patients having a subdural and/or intracerebral, in order to study the evolution of the signals of these two types of hematomas., Material and Methods: This prospective study included patients hospitalized for post-traumatic acute subdural or intracerebral hematoma. The protocol included an emergency brain CT and 4 MRI at fixed times: in emergency (early phase), between the third and the seventh day (early subacute phase), during the third week (late subacute phase), and after four months after the hemorrhage. The protocol included T1-weighted sequences before and after injection of gadolinium, T2-weighted, fluid-attenuated inversion-recovery (FLAIR), gradient echo and diffusion., Results: Eighteen patients were included and all 72 MRI were interpretable. The time course of the cerebral hematomas was similar to that described in the literature, whereas that of subdural hematomas was different in 15 patients. This distinction was significant in the early phase for subdural hematomas, which displayed hypersignal in T2 and FLAIR, whereas cerebral hematomas showed a hyposignal in the same sequences. The variation was also notable in the early subacute period during which subdural hematomas displayed hypersignal in T1, FLAIR and diffusion, and isosignal in T2, whereas cerebral hematomas showed isosignal in T1, and hyposignal in T2, FLAIR and diffusion., Conclusion: The time course of MRI signal of subdural hematomas is different from that of cerebral hematomas. This difference is significant in T2 sequence and FLAIR, especially in the early subacute period. These radiographic observations in adults can be useful for the MRI dating of subdural hematomas in shaken-baby syndrome.

The notion of emergency with regards to pediatric neuroimaging requires a strong knowledge of clinical indications. In children under 2 years of age, head trauma requires a CT scan in case of repeated or prolonged or rapidly increasing vomiting, focal signs, loss of consciousness, unusual behavior, seizures, clinical signs of skull fracture or polytrauma. The "shaken baby syndrome" is usually suspected in case of loss of consciousness or seizures before 8 months of age. The hematomas that are observed are subdural in location, diffuse and deeply located. Imaging is only mandatory for headache suggesting underlying space occupying lesion: permanent or increasing pain, nocturnal headache, headache during postural changes or efforts, associated to seizures or abnormal neurological examination. No imaging is indicated in case of first epileptic seizure associated to normal neurological examination and without any particular context. The presence of trauma, intracranial hypertension, persisting disturbances of consciousness or associated focal sign necessitates urgent neuroimaging. No imaging is indicated in case of typical febrile seizures, i.e. generalized, brief and occurring between 1 and 5 years of age. Spinal cord symptoms require immediate MRI evaluation. The most frequent tumor is neuroblastoma. In the absence of spinal tumor, brain abnormalities must be excluded (inflammatory disease). In neonates, CT scan or MRI must be readily performed in case of seizures or loss of consciousness to exclude ischemic, traumatic or infectious lesions.

Diagnosis of nonaccidental injury (child abuse) may be difficult because most infants present with non-specific clinical findings and without external signs of trauma. Brain lesions severely disproportionate to the history of trauma, retinal hemorrhages and characteristic fractures or fractures of varying age are key indicators to child abuse when encountered in an infant. It is therefore incumbent upon the radiologist to recognize the radiologic findings of the various forms of nonaccidental injury and to correlate them with the physical findings in order to render a more accurate opinion. Craniocerebral injuries are not uncommon in infants who are physically abused and have a worse long-term outcome than accidental injuries. The particularities of the infant's skull and its content and the pathophysiology of cerebral nonaccidental injuries are remembered. The imaging findings in infants with blunt impact, shaken- and whiplash shaken-injuries are emphasized. The combination of edema, malignant hyperaemic cerebral swelling, hypoxic-ischemic brain injury, diffuse axonal injuries, and bilateral and/or interhemispheric subdural hematomas is almost typical of a shaken infant. MRI, with its multiplanar capability and its sensitivity to cytotoxic edema and to degraded hemoglobin, is the modality of choice for detecting cerebral lesions in nonaccidental injury.