J Korean Neurosurg Soc.  2022 May;65(3):380-384. 10.3340/jkns.2021.0285.

Abusive Head Trauma in Infants and Children in Japan

• Nonaka M
• Asai A

• KMID: 2529582
• DOI: http://doi.org/10.3340/jkns.2021.0285

Abstract

Subdural hematoma in infants can be caused by abuse, and is thought to be more likely if subdural hematoma is associated with retinal hemorrhage and cerebral edema. In Japan, few doctors disagree that cases of subdural hematoma with retinal hemorrhage and cerebral edema with multiple findings on the body are more likely to have been caused by abuse rather than by household accident. On the other hand, in cases where there are no other significant physical findings, only subdural hematoma and retinal hemorrhage, there is a difference of opinion as to whether the injury was caused by an accident or abuse. The reason for this is that neurosurgeons in Japan promoted the concept that infants can develop subdural hematomas and retinal hemorrages due to minor trauma at home before the concept of abusive head trauma became known. In addition, the age distribution of subdural hematomas in Japan differs from that in other countries, with peaks at around 8 months, and the reason for this remains unclear. Therefore, the etiology of infant subdural hematoma in Japan needs to be investigated in greater detail.

Keyword

Abusive head trauma; Subdural hematom; Japanese

Figure

• 

  Fig. 1. Age distributions of subdural hematoma cases described in the articles by Kivlin [14] (A), Aoki and Masuzawa [1] (B), and Nishimoto and Kurihara [19] (C).

• 

  Fig. 2. A : A 6-month-old infant with benign external hydrocephalus. The guardian accidentally dropped the infant and bruised the infant’s head; computed tomography (CT) scan shows a subdural hematoma in convexity (white arrows). B : A 5-month-old infant who was injured by abuse. The guardian confessed to having abused the infant. CT scan showed subdural hematoma in the interhemisphere (white arrows) and brain edema in the left temporal-occipital lobe (black arrows).

Reference

References

1. Aoki N, Masuzawa H. Infantile acute subdural hematoma. Clinical analysis of 26 cases. J Neurosurg. 61:273–280. 1984.

2. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. Am J Roentgenol Radium Ther. 56:163–173. 1946.

3. Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics. 54:396–403. 1974.

4. Chadwick DL, Bertocci G, Castillo E, Frasier L, Guenther E, Hansen K, et al. Annual risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics. 121:1213–1224. 2008.

5. Choudhary AK, Servaes S, Slovis TL, Palusci VJ, Hedlund GL, Narang SK, et al. Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol. 48:1048–1065. 2018.

6. Duhaime AC, Christian CW. Abusive head trauma: evidence, obfuscation, and informed management. J Neurosurg Pediatr. 24:481–488. 2019.

7. Frasier LD, Kelly P, Al-Eissa M, Otterman GJ. International issues in abusive head trauma. Pediatr Radiol 44 Suppl. 4:S647–S653. 2014.

8. Gardner HB. Retinal and subdural haemorrhages: Aoki revisited. Br J Ophthalmol. 87:919–920. 2003.

9. Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J. 2:430–431. 1971.

10. Högberg U, Andersson J, Squier W, Högberg G, Fellman V, Thiblin I, et al. Epidemiology of subdural haemorrhage during infancy: a population-based register study. PLoS One. 13:e0206340. 2018.

11. Högberg U, Squier W, Andersson J, Högberg G, Fellman V, Thiblin I, et al. Do inter-country differences in the frequency of abusive head trauma reflect different proportions of overdiagnosis of abuse or true differences in abuse? J Epidemiol. 30:276–277. 2020.

12. Ikeda A, Sato O, Tsugane R, Shibuya N, Yamamoto I, Shimoda M. Infantile acute subdural hematoma. Childs Nerv Syst. 3:19–22. 1987.

13. Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK. The battered-child syndrome. JAMA. 181:17–24. 1962.

14. Kivlin JD. A 12-year ophthalmologic experience with the shaken baby syndrome at a regional children's hospital. Trans Am Ophthalmol Soc. 97:545–581. 1999.

15. Levin AV. Retinal hemorrhage in abusive head trauma. Pediatrics. 126:961–970. 2010.

16. Lynøe N, Elinder G, Hallberg B, Rosén M, Sundgren P, Eriksson A. Insufficient evidence for 'shaken baby syndrome' - a systematic review. Acta Paediatr. 106:1021–1027. 2017.

17. Maguire SA, Watts PO, Shaw AD, Holden S, Taylor RH, Watkins WJ, et al. Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review. Eye (Lond). 27:28–36. 2013.

18. Nakamura N, Kobayashi S, Hirakawa K, Yamada H, Jinbo M. Characteristics of head injuries and intracranial hematoms in infants and children. II. Acute and subacute intracranial hematoma. No To Shinkei. 17:785–794. 1965.

19. Nishimoto H, Kurihara J. Re-estimation of acute subdural hematoma in children caused by trivial household head trauma. Shoni No Noshinkei. 31:215–223. 2006.

20. Rekate HL. Subdural hematomas in infants. J Neurosurg. 62:316–317. 1985.

21. Vinchon M, de Foort-Dhellemmes S, Desurmont M, Delestret I. Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases. Childs Nerv Syst. 26:637–645. 2010.

22. Yamaoka Y, Fujiwara T, Fujino Y, Matsuda S, Fushimi K. Incidence and age distribution of hospitalized presumptive and possible abusive head trauma of children under 12 months old in Japan. J Epidemiol. 30:91–97. 2020.