Fatal spontaneous subdural bleeding due to neonatal giant cell hepatitis: a rare differential diagnosis of shaken baby syndrome

• Published in: Forensic science, medicine, and pathology Vol. 7; no. 3; pp. 294 - 297
• Main Authors: Guddat, Saskia S., Ehrlich, Edwin, Martin, Hubert, Tsokos, Michael
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-09-2011; Springer
• Subjects: Brain Edema - etiology; Brain Edema - pathology; Case Report; Criminology and Criminal Justice; Diagnosis; Diagnosis, Differential; Female; Forensic Medicine; Forensic Pathology; Giant Cells - pathology; Hematoma, Subdural - etiology; Hematoma, Subdural - pathology; Hepatitis; Hepatitis - congenital; Hepatitis - pathology; Humans; Infant; Infants (Newborn); Medicine; Medicine & Public Health; Pathology; Retinal Hemorrhage - etiology; Retinal Hemorrhage - pathology; Shaken baby syndrome; Shaken Baby Syndrome - diagnosis; Shaken baby syndrome; Neonatal giant cell hepatitis; Retinal haemorrhage; Subdural bleeding
• ISSN: 1547-769X; 1556-2891
• DOI: 10.1007/s12024-011-9227-8

A 7-week-old girl showed vomiting after feeding, facial pallor, loss of muscle tone and respiratory depression. An emergency doctor performed successful resuscitation and after arrival in hospital, cranial ultrasound showed left-sided subdural hemorrhage, cerebral edema with a shift of the midline, and a decrease in cerebral perfusion. Ophthalmologic examination showed retinal hemorrhage. In view of this, the doctors suspected shaken baby syndrome and approached the parents with their suspicions, but they denied any shaking or trauma. Despite surgery for the subdural hemorrhage the girl died a few hours later with a severe coagulopathy. Autopsy verified subdural hemorrhage, cerebral edema and retinal hemorrhage, but also revealed intact bridging veins and a lack of optic nerve sheath hemorrhage, therefore shaken baby syndrome could not be proven by autopsy. Histological examination showed severe neonatal giant cell hepatitis as the cause of the severe coagulopathy and the associated spontaneous subdural bleeding. Neonatal giant cell hepatitis may be responsible for unexpected deaths in infancy and, although rarely associated with subdural bleeding, must be considered as a potential differential diagnosis of shaken baby syndrome.