Anatomie et physiologie : recherches en cours
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Pseudo-Shaken-Baby-Syndrome: A Re-assessment of Shaken-Baby-Syndrome Features

Talbert DG

Abstract: Electron microscopy has revealed that sliding of the brain cortex relative to the skull cannot take place without producing contusions, which the SBS definition says are unusual in SBS. There is no natural “Subdural Space” across which sliding can take place and relative movement across the subarachnoid space is restricted by collagen reinforced trabeculae. The SBS definition can be interpreted as a different syndrome (Pseudo-SBS or P-SBS) involving venous hypertension, having a natural physiological etiology and not involving imposed trauma. Pre event history: Patients may have a history of poor feeding, vomiting, and lethargy for days or weeks. Extended vomiting is known to cause Mallory-Weiss tears in the mucosa at the junction of the esophagus and stomach. The infant is crying excessively because of pain. Infants may become anemic due to occult bleeding from such sites. The triad: Subdural bleeding: SBS is known to be associated with “Forceful” (projectile) vomiting, an indicator of Pyloric Stenosis, in which very high intra-abdominal pressures are involved. Pressurized venous blood may be driven up the vena cavae, into the head including the Superior Sagittal Sinus and bridging veins. It is at this junction that subdural bleeds occur. Retinal Hemorrhages: It occurs in many situations involving extreme intra-abdominal pressure (Valsalva Retinopathy), including forceful vomiting and retching. Altered consciousness: If the Internal Jugular Vein valves allow jugular venous reflux, “Transient Global Amnesia” may result. Very high pressure may produce permanent brain injury. Other features: Diffuse cerebral edema, Macrocephaly etc. result from elevated cerebral venous pressure effusions. The 2:1 M or F infant gender ratio in SBS convictions is accounted for by testosterone accelerated pyloric muscle bulk growth. Summary: The AAP definition of the physiological features of Shaken Baby Syndrome does define a genuine syndrome, but the cause is physiological not imposed trauma.