Previously known as 'shaken-baby syndrome,' many experts now feel that severe deceleration injuries (i.e., swinging the head against an immobile object such as a wall) are often involved. Clinically, varying degrees of brain injury are noted, associated with acute subarachnoid, subdural and retinal hemorrhages. Some children may present with acute subdural hematoma and chronic, proteinaceous extra-axial fluid collections suggestive of multiple traumatic episodes.
Acute management of shaking-impact syndrome involves operative removal of significant intracranial hemorrhages when these are present. The role of intracranial pressure monitoring and ventricular drainage is controversial in young infants with widely open sutures and fontanelles. Unfortunately, infants with injuries severe enough to cause prolonged coma and cerebral edema commonly have devastating neurological outcomes in any case. Chronic extra-axial fluid collections are generally treated with subdural-to-peritoneal shunting.
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