Battered baby syndrome. Report of a case with severe sequelae

Objective: To present a case with shaken-baby syndrome after having seizures and respiratory problems.

Methods: A previously normal child of 7 months of age presented an acute picture of status epilepticus with respiratory problems and periods of apnea. He was studied with electroencephalography, computerized tomography, magnetic resonance (MR) imaging and spectroscopic-MR. The child showed the presence of small subdural and epidural hematomas in both frontal regions 24 hours after the onset of the problem. The follow-up with MR studies revealed voluminous subdural bilateral hygroma that increased the size along the following six months, despite treatment with bilateral subdural-peritoneal shunt, and the patient showed infantile spasms. At 8 years of age, the patient shows severe mental retardation with autistic behavior and blindness, though he is able to walk without help and he has not seizures. The subdural hygroma decreased the size, but MR shows severe cortico-subcortical atrophy of both parieto-occipital regions. Spectroscopic MR study discloses severe neuronal lost and gliosis.

Conclusions: The shaken-baby syndrome causes severe encephalopathy and vision problems, blindness in many cases, after showing voluminous subdural and/or epidural hematomas which lead to a severe neuronal lost and gliosis. Shaken-baby syndrome is not always associated with skull fracture nor is necessarily related with battered-child syndrome.