Refractory status epilepticus presenting as shaken baby syndrome

• Published in: Revista de neurologiá Vol. 58; no. 12; pp. 548 - 552
• Main Authors: Fernandez-Menendez, Andrea, Buenache-Espartosa, Raquel, Coca-Perez, Ana, Morillo-Carnero, Pablo, Martinez-San Millan, Juan, Lorenzo-Sanz, Gustavo
• Format: Journal Article
• Language: Spanish
• Published: Spain 16-06-2014
• Subjects: Anticonvulsants - therapeutic use; Brain Damage, Chronic - etiology; Bronchiolitis - complications; Bronchiolitis - virology; Child Abuse - diagnosis; Diffuse Axonal Injury - diagnosis; Diffuse Axonal Injury - diagnostic imaging; Diffuse Axonal Injury - etiology; Drug Resistance; Epilepsy, Absence - drug therapy; Epilepsy, Absence - etiology; Hematoma, Subdural, Intracranial - etiology; Humans; Infant; Male; Respiratory Syncytial Virus Infections - complications; Retinal Hemorrhage - diagnosis; Retinal Hemorrhage - etiology; Shaken Baby Syndrome - complications; Shaken Baby Syndrome - diagnosis; Shaken Baby Syndrome - diagnostic imaging; Status Epilepticus - drug therapy; Status Epilepticus - etiology; Tomography, X-Ray Computed
• ISSN: 1576-6578
• DOI: 10.33588/rn.5812.2013461

A convulsive status in infants is usually triggered by a febrile syndrome secondary to an intercurrent infection or an infection affecting the central nervous system. Shaken baby syndrome is characterised by its association with bilateral or multifocal haemorrhage, retinal haemorrhage and encephalopathy. Children under one year old are the group with the highest risk, with a maximum incidence reaching a peak between 10 and 16 weeks of age. Intercurrent processes, such as baby colic or febrile syndromes that tend to step up crying, are usually precipitating factors of shaking.
We present the cases of two infants who began with a status epilepticus within a context of a febrile syndrome. Imaging tests revealed bilateral subdural haematomas in different stage of progress and bilateral retinal haemorrhages were observed in the fundus oculi of both children.
In a child with an unspecific febrile process that develops a convulsive status, the professional should suspect, in addition to more usual problems, shaken baby syndrome as a possible causation, above all if the child is under six months old.