A thoracolumbar subdural hematoma (SDH) resulting from nonaccidental trauma in a 4-month-old infant is reported from Women and Children’s Hospital, University of Buffalo, NY. The patient was noted to be apneic and had been shaken by a parent in an attempt to stimulate respiration. In the ED he was unresponsive and was diagnosed with myelopathy. In addition to bilateral clonus and extensor plantar responses, he had a bulging fontanelle, bruising on left shoulder, and retinal hemorrhages. Head CT showed SDH and subarachnoid hemorrhage. MRI of spine showed a SDH dorsal to the spinal cord with mass effect on the conus medullaris and descending nerve roots. Emergency T-12 to L-3 laminectomies were performed, and the hematoma was evacuated. Later, he required a ventriculoperitoneal shunt, and currently, he has severe developmental delay. [1]
COMMENT. Spinal cord injury is an uncommon complication of shaken baby syndrome, and may be overlooked when associated with head trauma. The authors explain the injury as a result of hyperflexion and hyperextension of the spine around the rigid rib cage. It is important to perform imaging of the spine, in addition to head and neck in infants with shaken baby syndrome.