A child brought to casualty with reports of violent shaking by parents. The most likely injury is?
**Core Concept**
Violent shaking in children, especially in abusive scenarios, commonly leads to traumatic brain injury due to rapid acceleration-deceleration forces. Subdural haematoma results from tearing of bridging veins between the dura and brain, which is highly characteristic of abusive head trauma (also known as "shaken baby syndrome").
**Why the Correct Answer is Right**
In shaken baby syndrome, violent shaking causes the brain to move within the cranial cavity, leading to tearing of bridging veins and subsequent subdural haemorrhage. This injury is often bilateral and shows classic imaging findings on CT scan. It is the most common and specific brain injury in such cases, and its presence strongly supports abusive trauma over accidental causes.
**Why Each Wrong Option is Incorrect**
Option A: Long bone fractures are more common in falls or high-impact trauma, not typically seen in shaken baby syndrome. They are not specific to violent shaking.
Option B: Ruptured spleen is more common in blunt abdominal trauma (e.g., car crashes), not in shaking. It is not a hallmark of abusive head trauma.
Option D: Skull bone fractures may occur in severe trauma, but they are less specific and less common than subdural haematoma in shaken baby syndrome.
**Clinical Pearl / High-Yield Fact**
Subdural haematoma is the most specific injury in abusive head trauma. Always consider shaken baby syndrome in any child with unexplained head injury, especially when there is no clear mechanism of trauma. Early recognition is critical for intervention and legal implications.
✓ Correct Answer: C. Subdural haematoma