Chapter 61 - Non-accidental brain injury

Summary

Head injuries may result from impact or shaking or a combination of these mechanisms, which act through translational or rotational forces. The classic presentation of non-accidental brain injury (NABI) in infants is the shaken baby syndrome (SBS), which is characterized by widespread parenchymal damage, diffuse axonal injury, subdural and/or subarachnoid hemorrhages, and retinal hemorrhages. Seizures occur more frequently in children with inflicted versus non-inflicted traumatic brain injury. Radiological imaging plays a crucial role in investigating NABI, in order to assess intracranial complications, guide clinical management, and provide documentary evidence for forensic investigation. Magnetic resonance imaging (MRI) detects hemorrhage in the sub acute stage (3-14 days) and demonstrates with high sensitivity early ischemic changes and diffuse axonal injury. Phenytoin has been considered the drug of choice for preventive treatment of early and late seizures while carbamazepine and valproate would be more suitable for the treatment of late seizures.