PMID: 3748020Jun 1, 1986Paper

Damage patterns in severe child abuse with and without fatal sequelae

Monatsschrift Kinderheilkunde : Organ der Deutschen Gesellschaft für Kinderheilkunde
G Jacobi

Abstract

In 62 battered children with involvement of the central nervous system clinically 3 patterns of impact to the skull, brain and its coverings could be distinguished: In 22 babies (mean age 6 months) the brain was damaged mainly by violent shaking. Many of those infants were in shock and epileptic status on admission. Retinal, subarachnoidal, and later subdural bleedings were recognizable. At first, all patients survived, but later 3 of them died in a vegetative state. Retinal bleedings are prompted by subarachnoidal hemorrhage due to shearing of bridging veins and by compression of the chest which immediately is followed by raise of venous pressure in the upper half of the body and by arteriospasms, leading to endothelial damage and increase of vascular permeability (Purtscher's disease). Both mechanisms result in severe retinal hemorrhage which might intrude into the vitreous body (Terson-syndrome). The consequences of violent shaking for the child might be disastrous mental retardation, microcephaly, spasticity, and epilepsies. The child might turn blind on one or both eyes; the visual failure is due to retinal scar formation, retinal detachment and fibrous organisation within the vitreous body on the one hand, due to raised i...Continue Reading

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