小兒科topic two: Abusive head trauma (AHT)

 Abusive head trauma (AHT)

1. Used to be called "shaken baby syndrome"

-- 80% due to physical abuse, therefore changed the name to AHT

-- Not likely to result from mild shakes or falling down from a short table by himself/herself

2. Patients: usually < 1 y/o, being abused many times

3. Prognosis: mortality 13~30%, handicapped 50~70%

4. Warning signs: 

-- Parents giving confusing information; especially young parents with financial stress

-- Burns, wounds (30~70%)

-- Seizure (40~70%)

-- Retinal hemorrhage (65~95%)

5. DDx:

-- Infection

-- Coagulopathy

-- Congenital defects

-- Accidental SDH (seizure/retinal hemorrhage-->uncommon, skull fracture-->more common)

6. Treatment:

-- Educate the parents

-- Drain CSF if high intracranial pressure (not doing this to remove blood clots!); 

   use EVD (external ventricular drainage) 

   or ETV (endoscopic third ventriculostomy) 

   or S-P shunt

7. High intracranial pressure: Cushing triad

-- Hypertension

-- Bradycardia

-- Irregular breathing

For babies, we can evaluate the anterior fontanelle to see if there's bulging due to high intracranial pressure.

8. CSF review:

-- Production: Choroid plexus in lateral ventricle 90%, 3rd and 4th ventricle 5%

-- Reabsorption: Luschka foramen *2, Magendie foramen*1

Amount: total 600~700 ml per day

Pressure: 9~18 mmH2O

Passage: Monro's foramen, Aqueduct