Abstract
In cases where carers have been convicted of Shaken Baby Syndrome the infant is twice as likely to be male as female. A similar 2:1 overrepresentation of males exists in Benign Hydrocephalus of Infancy, also known as Normal Pressure Hydrocephalus (NPH). It has previously been shown that excessive intra-abdominal pressures, occurring in paroxysmal coughing, retching or vomiting, can be communicated to intracranial veins. It is proposed that the missing pressure in NPH is this transient cerebral venous hypertension, in particular that caused by violent retching and vomiting in pyloric stenosis which also shows a 2:1 M/F ratio. Distension of intra cranial veins and capillaries would temporarily increase brain volume which would stimulate the dura to signal suture growth to the dimensions occurring during, and just after, the transient pressure surge. The pressure surge in capillaries throughout the brain would force water out through their walls into the interstitium. This water would then diffuse out through the brain surface, producing subarachnoid collections. At higher pressures the capillary endothelial cell tight junctions would separate, exposing the porous basement membrane, through which proteins could escape. At higher pressures still, some capillaries and veins would burst, producing the symptoms of Shaken Baby Syndrome.
Highlights
When Miller and Miller [1] searched MEDLINE using the Keywords “Shaken Baby Syndrome”, “Retinal Hemorrhage”, and “Subdural Hematoma” to select SBS convictions, they found male infants outnumbered female infants by about 2:1
Dura Mater review of the current knowledge of Benign Hydrocephalus of Infancy (BHI) [7] note a subgroup, “external hydrocephalus”. (In the following direct quotes are shown in italics) They say: It is usually defined as a rapid increase in head circumference, combined with enlarged subarachnoid spaces as seen on neuroimaging – especially overlying the frontal lobes – and normal or only moderately enlarged ventricles
The factors seen on imaging, further support this concept. It follows that the overrepresentation of males in Pyloric Stenosis, which is the source of the pressure, should appear in External Hydrocephalus; and it does
Summary
When Miller and Miller [1] searched MEDLINE using the Keywords “Shaken Baby Syndrome”, “Retinal Hemorrhage”, and “Subdural Hematoma” to select SBS convictions, they found male infants outnumbered female infants by about 2:1. The interventricular foramina and the cerebral aqueduct (Figure 1) are physically vulnerable to closure, blocking flow and causing pressure to build in ventricles upstream This all occurs within the brain and the resultant forms of hydrocephalus are classed as internal hydrocephalus. (In the following direct quotes are shown in italics) They say: It is usually defined as a rapid increase in head circumference, combined with enlarged subarachnoid spaces as seen on neuroimaging – especially overlying the frontal lobes – and normal or only moderately enlarged ventricles. Like the jugular veins the vertebral veins drain into the ipsilateral brachiocephalic vein and have a valve just
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