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RA Minns
Journal Issue: 
Volume 35: Issue 1: 2005




Recent controversies have focused on whether shaking can injure the infant  brain  and  if  a  diagnosis  of  SBS  can  be  confidently  made  and  distinguished from accidents (short falls) and non-traumatic conditions.

This  article  reviews  documented  cases,  animal,  biomechanical,  and  computer- modelling  evidence  to  support  the  contention  that  shaking  alone  without additional  impact  results  in  a  rotational  brain  injury  with  tearing  of  cortical emissary  veins, parenchymal  shearing, cervico-medullary, and  hypoxic-ischaemic injury.

While the terminology SBS is best avoided because it implies a mechanism in what is usually an unwitnessed injury, a more secure diagnosis of NAHI can be offered, with varying degrees of certainty, based on clinical, imaging, and ophthalmological findings after excluding conditions simulating these features.

The type of brain injury (inertial, contact, hypoxic-ischaemic) and the context in which  it  is  sustained, may  enable  an  opinion  about  whether  the  mechanism  is consistent with either a purely rotational or rotational impact-deceleration injury, compressive, penetrative or other combined mechanism.