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Battered child syndrome, a not uncommon problem, may involve deep structures including the liver, spleen, and brain. While involvement of kidneys is extremely rare, such an association is illustrated by the following case which presented with azotemia and hypertension. Management should depend on the degree of renal failure and hypertension as well as the extent of any electrolyte imbalance.
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The battered child syndrome is not an unusual problem to be encountered in a clinical orthopedic practice. The manifestations in abused children may be varied and many, necessitating that orthopedists be familiar with the ways in which affected children present to reduce the unfortunate consequences that occur when abuse is not initially recognized. Our purpose in reporting the case of an abused child is to attract the attention of the orthopedic surgeon, who may be the initial physician to see a battered child, to an unusual presentation of this syndrome which simulated myositis. The association of myositis with battered child syndrome has not been previously encountered in the orthopedic literature.
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Skeletal lesions observed in battered children include fractures, subperiostal new bone formation, irregular metaphyses, and cone-shaped epiphyses. A 4-year-old girl presented with bone pain. Radiographs revealed multiple fractures and epiphyseal and metaphyseal lesions highly significant for battered child syndrome. Six weeks later the authors diagnosed primary multifocal skeletal non-Hodgkin lymphoma. This case report illustrates that multifocal skeletal non-Hodgkin lymphoma is a differential diagnosis of battered child syndrome.
The diagnosis of battered child syndrome in infants was reached on the basis of the risk factors appraisal in social and family history, combined with clinical and roentgenographic examinations; the difficulties in establishing the diagnosis are presented. Long hospitalisation also revealed that the observed injuries are due to child abuse. The interdisciplinary approach is needed when non-accidental injuries are considered.
We present 2 cases of battered child syndrome with retinal hemorrhage. Case 1 is a 6-year-old boy who was blinded in both eyes following abuse by his mother's common-law husband. Retinal hemorrhages and optic atrophy were found in both eyes. Case 2 is a 6-month-old boy who developed dyspnea following episodes of abuse by his mother's common-law husband. Retinal hemorrhages were visible in both fundi. We believe that retinal hemorrhage is the most frequent clinical finding in abused children and its presence should alert the ophthalmologist to suspect battered child syndrome.
The term "battered-child syndrome" was coined by Kempe in 1962. The morphology of brain lesions in abused children is rarely reported in Japan. This clinicopathological entity in the central nervous system is characterized by retinal hemorrhages, subdural and subarachnoid hemorrhage. However, reports on microscopic findings of intracerebral lesion are fewer than those on macroscopic findings of scalp, skull and intracranial cavity. This study was performed on 8 cases of battered children who were autopsied. They consisted of six female and two male infants. The age ranged from one week to four years old. The causes of the injuries were shaking in four cases, throwing in three cases, dropping in two cases and strangling in one case, mostly in combination. CT scans were examined for three cases. CT scan revealed acute cerebral swelling and acute subdural hematoma with interhemispheric blood clot in three cases and multiple low density area in one case. Evacuation of the subdural hematoma and external decompression was performed in one case. The survival period from injury to death was one day in four cases, and 2, 3, 9 and 41 days in the others. In the gross anatomical findings there are many excoriations and bruises of the face and scalp in five cases, widespread subcutaneous hematoma in all cases and skull fracture in only two cases. The brain weight was exceedingly heavier than normal brain weight by age in five cases. In the macroscopic findings, there were marked cerebral swelling and cerebral herniation in all cases, traumatic subarachnoid hemorrhage in six cases, and thin widespread acute subdural hematoma with interhemispheric clot in four cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Data on 7 cases of battered child syndrome with neurological complications are reviewed. First symptoms were convulsions and bulged fontanel of undetermined origin. At clinical examination the unexpected presence of retinal hemorrhage in 5/7 patients has been the main criteria to diagnostic definition. CT showed the presence of subdural collections in the majority of the patients. A normal CT, however, does not display the possibility of future problems. Successive CT studies have proved useful. In two cases they demonstrated the appearance of diffuse images of central nervous system destruction some weeks later, and probably related to ischaemic troubles in connection with the aggression mechanisms.