Squier Waney
Department of Neuropathology, John Radcliffe Hospital, Oxford, UK.
Dev Med Child Neurol. 2008 Jan;50(1):10-4. doi: 10.1111/j.1469-8749.2007.02004.x.
Shaken baby syndrome (SBS), characterized by the triad of subdural haemorrhage, retinal haemorrhage, and encephalopathy, was initially based on the hypothesis that shaking causes tearing of bridging veins and bilateral subdural bleeding. It remains controversial. New evidence since SBS was first defined three decades ago needs to be reviewed. Neuropathology shows that most cases do not have traumatic axonal injury, but hypoxic-ischaemic injury and brain swelling. This may allow a lucid interval, which traumatic axonal injury will not. Further, the thin subdural haemorrhages in SBS are unlike the thick unilateral space-occupying clots of trauma. They may not originate from traumatic rupture of bridging veins but from vessels injured by hypoxia and haemodynamic disturbances, as originally proposed by Cushing in 1905. Biomechanical studies have repeatedly failed to show that shaking alone can generate the triad in the absence of significant neck injury. Impact is needed and, indeed, seems to be the cause of the majority of cases of so-called SBS. Birth-related subdural bleeds are much more frequent than previously thought and their potential to cause chronic subdural collections and mimic SBS remains to be established.
摇晃婴儿综合征（SBS）的特征为硬膜下出血、视网膜出血和脑病三联征，最初基于这样一种假说，即摇晃会导致桥静脉撕裂和双侧硬膜下出血。该综合征仍存在争议。自30年前首次定义SBS以来的新证据需要重新审视。神经病理学显示，大多数病例并无创伤性轴索损伤，而是存在缺氧缺血性损伤和脑肿胀。这可能会出现清醒期，而创伤性轴索损伤则不会。此外，SBS中的薄层硬膜下出血不同于创伤性的厚层单侧占位性血凝块。它们可能并非源于桥静脉的创伤性破裂，而是如1905年库欣最初所提出的，源于因缺氧和血流动力学紊乱而受损的血管。生物力学研究一再未能表明，在无明显颈部损伤的情况下，仅摇晃就能产生三联征。需要有撞击，而且实际上，撞击似乎是大多数所谓SBS病例的病因。与出生相关的硬膜下出血比以前认为的更为常见，其导致慢性硬膜下积液并酷似SBS的可能性仍有待确定。
