Prognosis and Neurologic Outcome in Shaken Baby Syndrome

Abstract

In the case of the shaken baby syndrome (SBS) as a kind of nonaccidental head injury (NAHI), the prognosis and outcome differ significantly from those of accidental head injury (AHI). Specially neurological deficits (in 60–70% of the survivors) in combination with a higher risk of mortality (20–25%) contribute to the morbidity rate of 90%. In SBS, special attention has also to be paid to specific mechanisms of injury: massive rotational and shear forces generate extensive subdural blood collections, as well as retinal hematomas causing neuronal dysfunction and cerebral damage. Repeated shaking and late presentation to medical services aggravate prognostic factors as time of reanimation, base deficit or Cytochrome C levels in the cerebrospinal fluid. Hypoxic and apoptotic processes conditioned by cervico-medullar and brainstem damage increase probability of cerebral edema and the loss of cellular autoregulation, as well as the instability of the blood–brain barrier. The destruction of large volumes of cerebral tissue regardless early neurosurgical decompressing craniectomies may result in partial blindness, motor and cognitive deficits, vegetative status or even death.