Shaken baby syndrome (síndrome do bebê chacoalhado): relato de caso

Fernandes, Yvens B.; Maciel Jr, Jayme A.; Guedes, Cláudio M. H.; Davoli, Adriana; Facure, Nubor O.

doi:10.1590/S0004-282X1995000400017

Resumos

Os autores relatam o caso de uma lactente de 50 dias de vida que foi trazida ao Pronto Socorro Pediátrico do Hospital de Clínicas da UNICAMP com crises convulsivas. Ao exame apresentava-se sem sinais externos de trauma, hipoativa e com crises convulsivas generalizadas. A fundoscopia evidenciou hemorragia retiniana difusa bilateral. Foi submetida a tomografia de crânio que mostrou hemorragia inter-hemisférica e "swelling" cerebral. A criança foi internada na UTI pediátrica, mantida sob ventilação assistida e recebendo hidantal porém, apesar do tratamento, evoluiu para óbito três dias depois. Desde o início havia suspeita de maus-tratos, o que foi confirmado um dia após a internação quando o pai relatou que "chacoalhou" a criança porque ela chorava bastante. O presente estudo tem como objetivo ressaltar aspectos sociais, epidemiológicos e a dificuldade diagnostica desta síndrome que algumas vezes pode ser fatal, como neste caso.

traumatismo crânio-encefálico; síndrome do bebê chacoalhado; maus-tratos

The authors report the case of a 50-day-old baby who was brought to the Pediatric Emergency Room of the "Hospital de Clinicas da UNICAMP" with seizures. At the examination she presented without external signs of trauma, hypoactive and with generalized seizures. Numerous hemorrhages were found in the ocular fundi. CT scan showed interhemisferic hemorrhage and brain swelling. The child was admitted to the Pediatric Intensive Care Unit, kept under controlled ventilation and hydantal. Although these measures, she died three days later. Since the beginning there was suspicion of child abuse. One day after the admission the father told that he had shaken the baby because she was crying too much. The present paper discuss social and epidemiological aspects, and about the difficulties in the diagnosis of this syndrome that sometimes may be fatal, as in this case.

head injury; shaken baby syndrome; child abuse

Shaken baby syndrome (síndrome do bebê chacoalhado). Relato de caso

Skaken baby syndrome: case report

Yvens B. Fernandes^I; Jayme A. Maciel Jr^I. Cláudio M. H. Guedes^II; Adriana Davoli^III; Nubor O. Facure^I

^IDepartamento de Neurologia. Estudo realizado na Faculdade de Ciências Médicas (FCM) da Universidade Estadual de Campinas (UNICAMP)

^IIDepartamento de Pediatria. Estudo realizado na Faculdade de Ciências Médicas (FCM) da Universidade Estadual de Campinas (UNICAMP)

^IIIDepartamento de Medicina Legal. Estudo realizado na Faculdade de Ciências Médicas (FCM) da Universidade Estadual de Campinas (UNICAMP)

RESUMO

Os autores relatam o caso de uma lactente de 50 dias de vida que foi trazida ao Pronto Socorro Pediátrico do Hospital de Clínicas da UNICAMP com crises convulsivas. Ao exame apresentava-se sem sinais externos de trauma, hipoativa e com crises convulsivas generalizadas. A fundoscopia evidenciou hemorragia retiniana difusa bilateral. Foi submetida a tomografia de crânio que mostrou hemorragia inter-hemisférica e "swelling" cerebral. A criança foi internada na UTI pediátrica, mantida sob ventilação assistida e recebendo hidantal porém, apesar do tratamento, evoluiu para óbito três dias depois. Desde o início havia suspeita de maus-tratos, o que foi confirmado um dia após a internação quando o pai relatou que "chacoalhou" a criança porque ela chorava bastante. O presente estudo tem como objetivo ressaltar aspectos sociais, epidemiológicos e a dificuldade diagnostica desta síndrome que algumas vezes pode ser fatal, como neste caso.

Palavras-chave:traumatismo crânio-encefálico, síndrome do bebê chacoalhado, maus-tratos.

SUMMARY

The authors report the case of a 50-day-old baby who was brought to the Pediatric Emergency Room of the "Hospital de Clinicas da UNICAMP" with seizures. At the examination she presented without external signs of trauma, hypoactive and with generalized seizures. Numerous hemorrhages were found in the ocular fundi. CT scan showed interhemisferic hemorrhage and brain swelling. The child was admitted to the Pediatric Intensive Care Unit, kept under controlled ventilation and hydantal. Although these measures, she died three days later. Since the beginning there was suspicion of child abuse. One day after the admission the father told that he had shaken the baby because she was crying too much. The present paper discuss social and epidemiological aspects, and about the difficulties in the diagnosis of this syndrome that sometimes may be fatal, as in this case.

Key words:head injury, shaken baby syndrome, child abuse.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 26-abriI-1995.

Dr. Jayme A. Maciel Jr. - Departamento de Neurologia, Hospital de Clínicas da UNICAMP - Caixa Postal 6111 13081-970 Campinas SP - Brasil.

1. Alexander RC, Schor DP, Smith WL. Magnetic resonance imaging of intracranial injuries from child abuse. J Pediatr 1986, 109:975-979.
2. Alexander RC, Crabbe L, Sato Y, Smith WL, Bennett T. Serial abuse in children who are shaken. AJDC 1990, 144:58-66.
3. Alexander RC, Sato Y, Smith WL, Bennett. Incidence of impact trauma with cranial injuries ascribed to shaking. AJDC 1990, 144:724-726.
4. Azevedo MA, Guerra VNA. Crianças vitimizadas: a síndrome do pequeno poder. São Paulo: Iglu, 1989.
5. Caffey J. Multiple fractures on the long bones of infants suffering from chronic subdural hematoma. Am J Roentgen 1946, 36:163-173.
6. Caffey J. On the theory and practice of shaking infants: its potential residual effects of permanent brain damage and mental retardation. J Dis Child 1972, 124:161-169.
7. Caffey J. The whiplash shaken infant syndrome: manual shaking by extremities with whiplash-induced intracranial and intraocular bleeding, linked with residual permanent brain damage and mental retardation. Pediatrics 1974, 54:396-403.
8. Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome: a clinical, pathological and biomechanical study. J Neurosurg 1987, 66:409-415.
9. Ellison PH, Tsai FY, Largent JA. Computed tomography in child abuse and cerebral contusion. Pediatrics 1978, 62:151-154.
¹⁰
Estatuto da Criança e do Adolescente. Lei 8069 de 13 de julho de 1990. São Paulo: Físico e contribuinte.
11. Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J 1971, 2:430-431.
12. Heifer RE, Slovis TL, Black M. Injuries resulting when small children fall out of bed. Pediatrics 1977, 60:4:533-535.
13. Hobbs CJ. Skull fractures and the diagnosis of abuse. Arch Dis Childh 1984, 59:246-252.
14. Kravitz H, Driessen G, Gomberg R, Korach A. Accidental falls from elevated surfaces in infants from birth to one year of age. Pediatrics 1969, 44:869-876.
15. Meservy CJ, Towbin R, Mc Laurin RL, Myers PA, Ball W. Radiographic characteristics of skull fratures resulting from child abuse. AJNR 1987, 8:455-457.
16. Mc Laurin RL, Towbin R. Diagnosis and treatment of head injury in infant and children. In Youmans JR (eds). Neurosurgical surgery. Ed 3. Philadelphia: W.B. Saunders. 1990, p 2149-2193.
17. Miziara CSMG, Serrano VAG, Kok F, Marques-Dias MJ. Síndrome da criança espancada: aspectos neurológicos em 7 casos. Arq Neuropsiquiatr 1988, 46:359-364.
18. Sato Y, Yuh WTC, Smith WL, Alexander RC, Kao SCS, Ellebroek CJ. Head injury in child abuse: evaluation with MR imaging. Radiology 1989, 173:653-657.
19. Shapiro K. Special consideration for the pediatric age group. In Cooper PR (ed). Head injury. Ed 2. Baltimore: Williams & Wilkins, 1987, p 367-387.
20. Teixeira WRG, Mori SS, Morrone Z Jr, Arias HS, Queiroz SM, Teixeira CMP. Síndrome do bebê espancado.
Rev Paul Med 1984, 102: 237-243.
21. Wilkinson WS, Han DP, Rappley MD, Owings CL. Retinal hemorrhage preditcs neurological injury in the shaken baby syndrome. Arch Ophthalmol 1989, 107:1472-1474.

Datas de Publicação

Publicação nesta coleção
20 Dez 2010
Data do Fascículo
Set 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alexander RC, Schor DP, Smith WL. Magnetic resonance imaging of intracranial injuries from child abuse. J Pediatr 1986, 109:975-979.

[2] 2. Alexander RC, Crabbe L, Sato Y, Smith WL, Bennett T. Serial abuse in children who are shaken. AJDC 1990, 144:58-66.

[3] 3. Alexander RC, Sato Y, Smith WL, Bennett. Incidence of impact trauma with cranial injuries ascribed to shaking. AJDC 1990, 144:724-726.

[4] 4. Azevedo MA, Guerra VNA. Crianças vitimizadas: a síndrome do pequeno poder. São Paulo: Iglu, 1989.

[5] 5. Caffey J. Multiple fractures on the long bones of infants suffering from chronic subdural hematoma. Am J Roentgen 1946, 36:163-173.

[6] 6. Caffey J. On the theory and practice of shaking infants: its potential residual effects of permanent brain damage and mental retardation. J Dis Child 1972, 124:161-169.

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

[8] 8. Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome: a clinical, pathological and biomechanical study. J Neurosurg 1987, 66:409-415.

[9] 9. Ellison PH, Tsai FY, Largent JA. Computed tomography in child abuse and cerebral contusion. Pediatrics 1978, 62:151-154.

[10] ¹⁰
Estatuto da Criança e do Adolescente. Lei 8069 de 13 de julho de 1990. São Paulo: Físico e contribuinte.

[11] 11. Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J 1971, 2:430-431.

[12] 12. Heifer RE, Slovis TL, Black M. Injuries resulting when small children fall out of bed. Pediatrics 1977, 60:4:533-535.

[13] 13. Hobbs CJ. Skull fractures and the diagnosis of abuse. Arch Dis Childh 1984, 59:246-252.

[14] 14. Kravitz H, Driessen G, Gomberg R, Korach A. Accidental falls from elevated surfaces in infants from birth to one year of age. Pediatrics 1969, 44:869-876.

[15] 15. Meservy CJ, Towbin R, Mc Laurin RL, Myers PA, Ball W. Radiographic characteristics of skull fratures resulting from child abuse. AJNR 1987, 8:455-457.

[16] 16. Mc Laurin RL, Towbin R. Diagnosis and treatment of head injury in infant and children. In Youmans JR (eds). Neurosurgical surgery. Ed 3. Philadelphia: W.B. Saunders. 1990, p 2149-2193.

[17] 17. Miziara CSMG, Serrano VAG, Kok F, Marques-Dias MJ. Síndrome da criança espancada: aspectos neurológicos em 7 casos. Arq Neuropsiquiatr 1988, 46:359-364.

[18] 18. Sato Y, Yuh WTC, Smith WL, Alexander RC, Kao SCS, Ellebroek CJ. Head injury in child abuse: evaluation with MR imaging. Radiology 1989, 173:653-657.

[19] 19. Shapiro K. Special consideration for the pediatric age group. In Cooper PR (ed). Head injury. Ed 2. Baltimore: Williams & Wilkins, 1987, p 367-387.

[20] 20. Teixeira WRG, Mori SS, Morrone Z Jr, Arias HS, Queiroz SM, Teixeira CMP. Síndrome do bebê espancado.

[21] Rev Paul Med 1984, 102: 237-243.

[22] 21. Wilkinson WS, Han DP, Rappley MD, Owings CL. Retinal hemorrhage preditcs neurological injury in the shaken baby syndrome. Arch Ophthalmol 1989, 107:1472-1474.