PubMed · 11654093
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Mark Curriden. 1993. Sterilization ordered for child abuser.. https://pubmed.ncbi.nlm.nih.gov/11654093/
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OBJECTIVES: Neonatal herpes simplex virus (HSV) encephalitis is rare, but associated with considerable morbidity and mortality. After a baby, subsequently proven to have HSE, had initially been diagnosed as non-accidental injury (NAI), we reviewed the clinical features and radiology of infants with HSE recently diagnosed by our laboratory. METHODS: Screening of cerebrospinal fluid (CSF) samples sent to Oxford for HSV polymerase chain reaction (PCR) analysis, from wide range of British hospitals, identified HSV infected infants. After a diagnosis was made, the case notes and neuroradiology (where available) were reviewed and a limited follow-up was undertaken. RESULTS: Thirteen infants had HSV encephalitis (HSE), which in four followed a relapsing course. On subsequent assessment six infants had neurological sequelae, six appeared to be normal, and one was lost to follow-up. Neither a history of primary HSV infection in pregnancy, nor skin lesions in the baby, were helpful diagnostically. Magnetic resonance imaging indicated haemorrhage in the cortex, but no subdural haematomata, a hallmark of NAI, in 5/6 infants. CONCLUSIONS: The early clinical features of HSE and NAI may be indistinguishable. As early diagnosis is important, infants with an unidentified encephalopathic illness should be examined by neuroradiology and their CSF tested for HSV DNA. Together these examinations can confirm and differentiate between those two conditions. Relapsing HSE may mimic recurrent encephalopathy caused by multiple NAIs.
The author autopsied a seven-month-old infant who was shocked repeatedly with a stun gun by his foster mother, in an attempt by the foster mother to get the infant to stop crying. The stun gun injuries were round, well-circumscribed, erythematous macular lesions, which were found in pairs. The lesions were 2 in. apart, and were found to match the distance between the electrodes of the stun gun found in the foster mother's purse. Based on the electrical output of the stun gun, the small size of the infant, location of stun gun discharge, and the decreased resistance of the infant's skin, it can be concluded that the stun gun injury is responsible for the infant's death.
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