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Derek A. Bruce, Luis Schut, Leonard A. Bruno, James H. Wood and Leslie N. Sutton

patients ranged in age from 4 months to 17 years, with a mean age for the group of 7.2 years. The etiology of the injury was: automobile accidents in 38 patients, falls in nine, child abuse in four, a sledding accident in one, and a soccer injury in one. Twenty patients were admitted within 6 hours of injury, 19 between 6 and 24 hours, 10 between 24 hours and 48 hours, and four between 48 hours and 7 days. Fourteen patients had associated injuries consisting of long-bone fractures or rupture of a viscus. Following emergency evaluation on arrival at CHOP, all patients

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Dachling Pang and James E. Wilberger Jr.

accident 1 4.2 fall from height 5 20.8 fall down steps 2 8.3 football tackle 1 4.2 diving 1 4.2 object fell on head 1 4.2 sled accident 1 4.2 wrestling 1 4.2 child abuse 1 4.2 The next most common causes involved falls from height: one from a crib, one in the gymnasium, and three from trees. Most of these children were under 8 years old. Two toddlers fell down steps at home by escaping the confines of their walkers. The other isolated causes were mainly sports-related, and

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Infantile acute subdural hematoma

Clinical analysis of 26 cases

Nobuhiko Aoki and Hideaki Masuzawa

patients had a significant medical history or were subjects of child abuse before the trauma. The surviving patients were followed for periods ranging from 4 months to 11 years with an average of 7.2 years. The most common cause of trauma was a fall backward while sitting or standing (16 or 61.5% of the 26 patients), and characteristically this disorder occurred by hitting the head against a soft item such as a Japanese tatami mat. TABLE 1 Summary of clinical data in 26 patients with infantile acute subdural hematoma * Case No

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syndrome” and are victims of child abuse. While not totally pathognomonic of shaking, the constellation of SDH and retinal hemorrhage in the context of a historically trivial injury should be regarded as whiplash shake syndrome unless another etiology can be determined. 1, 2 When dealing with trauma in infants it is essential to maintain a degree of skepticism with regard to the trivial nature of the injury. 3, 4 It is inconceivable that bilateral SDH's with retinal hemorrhages could result from such minor head injuries. References 1. Caffey J

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The shaken baby syndrome

A clinical, pathological, and biomechanical study

Ann-Christine Duhaime, Thomas A. Gennarelli, Lawrence E. Thibault, Derek A. Bruce, Susan S. Margulies and Randall Wiser

infantile child abuse and has been postulated as a cause of developmental delay in survivors. 4, 15 While the term “shaken baby syndrome” has become well entrenched in the literature of child abuse, it is characteristic of the syndrome that a history of shaking in such cases is usually lacking. 12 Shaking is often assumed, therefore, on the basis of a constellation of clinical findings and on the computerized tomography (CT) picture of subarachnoid and subdural hematomas, particularly in the posterior interhemispheric fissure. 17 Because of the ambiguous circumstances

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morbidity in one series. 2 This particular emphasis is, of course, the author's prerogative and appears to be one of the main thrusts of the paper. One wonders, though, if this approach might give readers the impression that shaking alone, without the associated blunt trauma, is a benign way of treating a child? If pediatricians concluded this, would they omit warnings about shaking from anticipatory guidance to parents? Also, an attorney attempting to discredit a physician's testimony in a child abuse hearing might misuse this report to conclude that there was no abuse

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Chronic subdural hematoma in infancy

Clinical analysis of 30 cases in the CT era

Nobuhiko Aoki

. There were eight patients in the infantile acute subdural hematoma group, which was characterized by a tonic convulsion and a preretinal hemorrhage shortly after mild head trauma. 3 Two patients who had sustained severe head trauma in traffic accidents were classified as having acute subdural hematoma. Two patients were victims of child abuse, which was confirmed by pediatricians and social workers at this hospital. Four patients were revealed to have suffered meningitis in early infancy. Two patients were identified as having hemorrhagic diathesis: one due to liver

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J. E. Scoble and C. W. H. Havard

factor: responses in normal subjects and patients with disorders of the hypothalmus and pituitary. Clin Endocrinol 20: 71–84, 1984 6. Miller WL , Kaplan SL , Grumbach MM : Child abuse as a cause of posttraumatic hypopituitarism. N Engl J Med 302 : 724 – 728 , 1980 Miller WL, Kaplan SL, Grumbach MM: Child abuse as a cause of posttraumatic hypopituitarism. N Engl J Med 302: 724–728, 1980 7. Stacpoole PW , Interlandi JW , Nicholson WE , et al : Isolated ACTH deficiency: a heterogeneous

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Mary A. Foulkes, Howard M. Eisenberg, John A. Jane, Anthony Marmarou, Lawrence F. Marshall and Traumatic Coma Data Bank Research Group

%) occurred on the highway. A majority of the gunshot wounds occurred at home (primarily suicide attempts). Alcohol or drug use were contributing factors in 38% and 7% of injuries, respectively. Additional contributing factors were suicide attempts and work-related injuries or child abuse. Note that factors contributing to the traumatic injury were frequently unknown, so that a high nonresponse rate resulted. Table 5 summarizes the neurological and psychiatric problems disclosed by the patients' history. Hypertension, although not very frequently compared to the general

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case we also initially entertained the possibility of child abuse, but this was subsequently ruled out. As mentioned in the article, there was a classic history of birth trauma with associated palsy of the upper limb. Concerning the management protocol, we believe that cervical spondyloptosis is an extreme form of cervical kyphosis, with loss of anterior structural support, which becomes severely unstable after any anterior decompressive surgery (corpectomies). Any form of pure posterior construct in such situations is unlikely to provide significant and continued