Shaking sets the head into a dangling motion and can cause whiplash spinal cord injury. In actuality, most child abuse injuries are a combination of shaking and blunt impact and the latter is now thought to be more important in their pathogenesis than shaking. Severe brain trauma in children also often causes HIE, extensive focal ischemic lesions, and cerebral edema. Retinal hemorrhages and hemorrhages within the optic nerve sheath are an important component of the shaking-impact syndrome and correlate with the severity of brain damage. They are probably caused by shaking of the globe and tearing of delicate retinal vessels.
Retinal hemorrhages are extremely uncommon in severe accidental brain injury.
Severe head trauma can also cause deep intracerebral hematomas and brain necrosis. Traumatic intracerebral hematomas are often multiple. They are found more commonly in the frontal and temporal white matter. They are probably due to rupture of intrinsic vessels as a result of angular rotation of the brain. It is can caused by DAI of the medulla or increased intracranial hypertention.