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Derek A. Bruce, Abass Alavi, Larissa Bilaniuk, Carol Dolinskas, Walter Obrist and Barbara Uzzell

. Ventriculomegaly was seen during recovery in 10 of 67 patients without initial diffuse swelling and cumulative GCS scores of less than 8. Diffuse enlargement was seen in only two, and this was minimal. Both of these children were shaken babies. Eight patients showed evidence of focal ventricular enlargement: five were shaken babies, and three had epidural hematomas. Intracranial hypertension was recorded in seven of the 10 patients. Thus, extracerebral collection and diffuse ventricular enlargement were not related simply to intracranial hypertension, subarachnoid hemorrhage, or

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Steven M. Grunberg Anna Marie Daniels Helmut Muensch John R. Daniels Leslie Bernstein Virginia Kortes Martin H. Weiss March 1987 66 3 405 408 10.3171/jns.1987.66.3.0405 The shaken baby syndrome Ann-Christine Duhaime Thomas A. Gennarelli Lawrence E. Thibault Derek A. Bruce Susan S. Margulies Randall Wiser March 1987 66 3 409 415 10.3171/jns.1987.66.3.0409 Effect of clot removal at 24 hours on chronic vasospasm after SAH in the primate model Michael Nosko Bryce K. A. Weir

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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

T he term “whiplash shaken baby syndrome” was coined by Caffey 3 to describe a clinicopathological entity occurring in infants characterized by retinal hemorrhages, subdural and/or subarachnoid hemorrhages, and minimal or absent signs of external trauma. Because a nursemaid admitted that she had held several such children by the arms or trunk and shaken them, the mechanism of injury was presumed to be a whiplash-type motion of the head, resulting in tearing of the bridging veins. Such an injury was believed to be frequently associated with fatalities in

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CT-Guided Needle Biopsy April 1988 68 4 10.3171/jns.1988.68.4.0655 Monitoring of Intracranial Pressure April 1988 68 4 10.3171/jns.1988.68.4.0657 Staged Treatment of AVM's April 1988 68 4 10.3171/jns.1988.68.4.0658 The Shaken Baby Syndrome April 1988 68 4 10.3171/jns.1988.68.4.0660 Nimodipine treatment in poor-grade aneurysm patients Kenneth C. Petruk Michael West Gerard Mohr Bryce K. A. Weir Brien G. Benoit Fred Gentili Lew B. Disney Moe I. Khan Michael Grace Renn O. Holness

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Neurosurgical Forum: Letters to the Editor To The Editor Sheldon L. Brenner , D.O. Howard Fischer , M.D. Children's Hospital of Michigan Detroit, Michigan 660 661 The report by Duhaime, et al. , troubles us (Duhaime AC, Gennarelli TA, Thibault AE, et al: The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66: 409–415, March, 1987). First, we are concerned about the way they apply “shaken baby syndrome” to their patient population. In addition, the

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Masaaki Shibata, Stephanie Einhaus, John B. Schweitzer, Samuel Zuckerman and Charles W. Leffler

animal models of percussive brain injury, CBF falls acutely in rats 2, 36, 43 and cats; 11, 28 however, there are also reports that percussive brain injury induces pial arteriolar dilation in cats. 13, 46 Brain injury has been reported in infants, 12, 24, 41 including the so-called “shaken baby syndrome;” however, in contrast to adults and older children, reports on infant brain injury are very limited, and clinical studies of cerebral hemodynamic changes following brain injury are scarce. The present study was undertaken to characterize acute changes in cerebral

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Matthieu Vinchon, Nathalie Noulé, Gustavo Soto-Ares and Patrick Dhellemmes

because, at the beginning of the study, the degree of suspicion toward child abuse was low and many SDHs were considered spontaneous. In retrospect, many of these cases were probably due to shaken-baby syndrome. Because of the surgical bias, our series does not allow calculation of the proportion of head-injured children requiring SDPD. Case Management The infants were admitted to our department either after the initial trauma or at the time SDH was diagnosed. More severely affected children were initially admitted to the intensive care unit and transferred to

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Helmut L. Laurer, Florence M. Bareyre, Virginia M. Y. C. Lee, John Q. Trojanowski, Luca Longhi, Rachel Hoover, Kathryn E. Saatman, Ramesh Raghupathi, Shigeru Hoshino, M. Sean Grady and Tracy K. McIntosh

: Increased anticholinergic sensitivity following closed skull impact and controlled cortical impact traumatic brain injury in the rat. J Neurotrauma 11: 275–287, 1994 18. Duhaime AC , Christian CW , Rorke LB , et al : Nonaccidental head injury in infants—the “shaken-baby syndrome.” N Engl J Med 338 : 1822 – 1829 , 1998 Duhaime AC, Christian CW, Rorke LB, et al: Nonaccidental head injury in infants—the “shaken-baby syndrome.” N Engl J Med 338: 1822–1829, 1998 19. Fineman I , Hovda DA , Smith M

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Michael T. Prange, Brittany Coats, Ann-Christine Duhaime and Susan S. Margulies

ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 90: 179–185, 1992 12. Duhaime AC , Gennarelli TA , Thibault LE , et al : The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66 : 409 – 415 , 1987 Duhaime AC, Gennarelli TA, Thibault LE, et al: The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66: 409–415, 1987 13. Ewing-Cobbs L , Kramer L , Prasad M , et al : Neuroimaging

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article (Prange MT, Coats B, Duhaime AC, et al: Anthropomorphic simulations of falls, shakes, and inflicted impacts in infants. J Neurosurg 99: 143–150, July, 2003) extends the work of two of the authors (Duhaime and Margulies) published by this journal 16 years ago. 1 The methodology used in the most recent paper, although more complex, seems to have produced results similar to the original work in one important aspect. One of the conclusions of the original paper is “… the shaken baby syndrome, at least in its most severe acute form, is not usually caused by