Abstract
In Japan, social concern for child abuse has risen since the enactment in 2000 of a law designed to prevent child abuse, the Abuse Prevention Law. Intracranial hemorrhage is the most serious problem in child abuse because it can result in fatality or a poor prognosis. Shaken baby syndrome (SBS) has become a familiar term and is used as a synonym for abusive head injury. But non-accidental traumatic brain injury (non-accidental TBI) or inflicted traumatic brain injury (ITBI) is more appropriate. This is because ITBI is not only caused by shaking but also by direct impact from hitting, dropping or throwing the child. For the diagnosis, it is important to check the whole body, such as for bruises, burns and fractures. MRI is an important modality to detect not only fresh hematomas but also old hematoma and hypoxic ischemic injury. Retinal hemorrhage is observed in 65〜89% of ITBI and it is a specific finding in ITBI. Therefore ophthalmoscopy is necessary in making the diagnosis. The most common findings in cases of ITBI are acute subdural hematoma along the inter-hemispheric fissure, over the convexities and around the cerebeller tentorium. Outcomes for children with ITBI is very poor. Their mortality rate ranges from 15 to 38%. Thirty percent to 50% of survivors have disabilities. Full recovery is estimated to be 30%. In 31〜43% of the cases, abuse is repeated after the patient returns home. Whether acute subdural hematomas accompanying retinal bleeding caused by domestic minor injury, which have hitherto been reported as Nakamura's type 1 of infantile acute subdural hematoma (IASDH), should be classified as abuse or as an other clinical entity still remains controversial.
