DIAGNÓSTICO DEL CASO CLÍNICO:
The initial CT scan of the head obtained in the ED (see Figure 2) shows bilateral subdural hematomas outlining bilateral cerebral convexities, with hyperdense blood noted in the left frontal lobe. The patient was started on fosphenytoin for seizure prophylaxis. The ophthalmologic examination revealed bilateral retinal hemorrhages extending into the periphery (see Figure 1). Intraretinal hemorrhages of the macula were noted in the left eye, with possible choroidal rupture. On careful questioning, the caretaker repeatedly denied any history of trauma. A skeletal survey was performed that revealed a healing right radial neck fracture. The medical record from the urgent care center was obtained; this included a clinical note dated 4 months prior to patient's presentation to the ED, which described a visit for repeated emesis and irritability. A bruise on the chin was noted on that visit, and the explanation given was a fall inside the patient's crib that occurred 4 days prior to that visit. A report to the Department of Children and Families was found to have been made for missed well-child visits. The level of suspicion for suspected abusive head trauma (AHT) and child abuse was extremely high. It is important for emergency clinicians to be mindful of the diagnosis of AHT, but there are other rare causes that can mimic abuse.
Abusive head injury, sometimes referred to as "shaken baby syndrome,"[1] is the most common cause of death resulting from child abuse.[2] The majority of cases occur in infants less than 1 year old.[3] Head injury among infants in this age group is often the result of abuse and the mechanism of injury, although much debated, is usually thought to be significant forces generated from angular deceleration with or without impact. AHT in this population represents a significant fraction of young children admitted for head injury.[4] Approximately 30% of children aged 0-3 years admitted to pediatric hospitals for intracranial injury have been found to meet the criteria for abuse.[5] Many children with AHT also have a clinical history or findings consistent with prior maltreatment. Crying is thought to be a trigger for many cases of AHT and prevention efforts are directed toward caregiver response to colicky babies and crying infants.
Diagnóstico final:
Síndrome del niño maltratado. Traumatismo craneoencefálico con hematomas subdurales bilaterales. Síndrome de hipertensión intracraneana.
LAMENTAMOS EL FALLECIMIENTO DEL AFAMADO DR. RAFAEL GALINA GALLEGOS
Hace unos días falleció el distinguido y prestigiado GINECOLOGO Dr. RAFAEL GALINA GALLEGOS. Un ícono de la Ginecología en Minatitlán, por su calidad profesional. Pionero, fundador y maestro de la Facultad de Medicina de Minatitlán. Jefe de Ginecología del Hosp. de Pemex durante muchos años. Padre de nuestro excelente amigo FALLO GALINA.Nuestro sentido pésame y un abrazo a toda la familia.
APEMI.
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