MR Imaging of Shaken Baby Syndrome Manifested as Chronic Subdural Hematoma Yul Lee, MD Kwan Seop Lee, MD Dae Hyun Hwang, MD In Jae Lee, MD Hyun Beom Kim, MD Jae Young Lee, MD Index terms : Brain, MR Children, central nervous system Children, injunies Korean J Radiol 2001;2:171-174 Received April 30, 2001; accepted after revision June 28, 2001. All authors: Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine Address reprint requests to: Yul Lee, MD, Department of Radiology, Hallym University Sacred Heart Hospital, 896 Pyungchon-dong, Dongan-gu, Anyang City, Kyungki-do 431-070, Korea. Telephone: (8231) 380-3881 Fax: (8231) 380-3878 e-mail: leeyul@www.hallym.or.kr Shaken baby syndrome (SBS) is a form of child abuse that can cause signifi- cant head injuries, of which subdural hematoma (SDH) is the most common man- ifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanced MRI revealed diffuse dural enhance- ment. I n child abuse victims, head injury is a major cause of morbidity and mor- tality (1 3). Shaken baby syndrome (SBS) is a form of abuse that can cause severe head injuries such as subdural hematoma, subarachnoid he- morrhage, hemorrhagic contusion, and/or diffuse axonal injury (4, 5). SBS, the most common pattern of child abuse, has been a medical and social issue in many developed countries and has recently become an issue in Korea. Because the clinical history is in many instances insufficient and SBS frequently leaves no external evidence of physical injury, imaging such as CT or MRI is very important. We describe three cases of SBS presenting as chronic subdural hematoma. CASE REPORTS Case 1 A three month-old baby girl was admitted to the emergency department because of a seizure which occurred the previous day. There was no fever, and no definite history of trauma. She was a term baby with no perinatal problems such as birth trauma, and the findings of physical and laboratory examinations were unremarkable. Simple skull and chest radiographs revealed no abnormality. MRI performed on the day of admis- sion showed left frontal subdural hematoma (SDH). The SDH signal was heteroge- neous (high and low) on T1-and T2-weighted images, suggesting rebleeding in chronic SDH. Contrast-enhanced MRI revealed diffuse dural enhancement in the left hemi- sphere (Fig. 1), and fundoscopic examination demonstrated the presence of bilateral retinal hemorrhage. There was no definite history of child abuse. Case 2 An eight-month-old baby boy was admitted to the emergency department with a seizure which occurred 40 minutes earlier. For three days he had shown symptoms of upper respiratory infection, and had mild fever. There was no definite history of trau- ma. He was a term baby with no perinatal problems, and the results of physical and Korean J Radiol 2(3), September 2001 171