Shaken Baby Syndrome (Abusive Head Trauma) presents with a classic triad. Which combination of findings constitutes the classic triad, and what is the mechanism?

• A Subdural hematoma + retinal hemorrhages + metaphyseal fractures — caused by rotational acceleration-deceleration forces on the immature brain ✓
• B Epidural hematoma + skull fracture + cerebral contusion — from direct impact
• C Subarachnoid hemorrhage + papilledema + cortical blindness — from hypertensive crisis
• D Subdural hematoma + fracture of femur + rib fractures — from direct beatings

Explanation

Abusive Head Trauma (Shaken Baby Syndrome) classic triad: (1) Subdural hematoma — from tearing of bridging veins crossing the subdural space during violent shaking; (2) Retinal hemorrhages — from repeated acceleration-deceleration causing vitreoretinal traction, resulting in intraretinal, preretinal, and even retinoschisis hemorrhages extending to the ora serrata (highly specific for abusive trauma when bilateral and extensive); (3) Diffuse hypoxic-ischemic brain injury. Metaphyseal (corner/bucket handle) fractures are classic associated findings (from grabbing the infant by the limbs). The mechanism is violent rotational acceleration-deceleration without necessary direct impact (though impact is often co-present). Epidural hematoma (B) typically results from direct skull trauma with middle meningeal artery injury.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.