Zusammenfassung
Etwa 1–10% aller Kindesmisshandlungen betreffen den Kopf und das Zentralnervensystem (ZNS). Als charakteristische Konstellation beim klassischen Schütteltrauma-Syndrom wird die Koinzidenz einer variablen, oft aber schweren und prognostisch ungünstigen diffusen Hirnschädigung (Enzephalopathie) mit subduralen Hämatomen und meist ausgeprägten retinalen Blutungen beschrieben. Bei einer bislang hohen Variabilität der Terminologie ist »Abusive Head Trauma« (AHT) mittlerweile der international empfohlene und anerkannte Begriff. Diese Verletzungen haben die gravierendsten Auswirkungen aller Misshandlungsformen, d. h. die höchste Morbidität und Mortalität. Nach amerikanischen Schätzungen sind 80% der Todesfälle durch ZNS-Verletzungen im Säuglingsalter auf Misshandlungen zurückzuführen. Insgesamt sind sie mit 66–75% die häufigste misshandlungsbedingte Todesursache und die häufigste Säuglingstodesursache im 2. Lebenshalbjahr. In etwa jeweils einem Drittel kommt es zu schweren, mittleren oder leichten bzw. fehlenden Folgeschäden. Das Risiko für junge männliche Säuglinge, Kinder aus belasteten sozioökonomischen Lebensumständen und Kinder alleinerziehender, junger Mütter ist erhöht. In etwa einem Drittel aller Fälle finden sich Hinweise auf vorhergehende Misshandlungen mit Schädigungen sowohl des Gehirns als auch anderer Organsysteme und vorherige Kontakte zur Jugendhilfe.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Literatur
Adamsbaum C, Grabar S, Mejean N, Rey-Salmon C (2010) Abusive head trauma: Judicial admissions highlight violent and repetitive shaking. Pediatrics 126: 546–555
Adamsbaum C, Morel B, Ducot B, Antoni G, Rey-Salmon C (2014 ) Dating the abusive head trauma episode and perpetrator statements: key points for imaging. Pediatr Radiol 44 Suppl 4: 578–88
American Academy of Pediatrics (AAP) (2001) Shaken Baby Syndrome: Rotational Cranial Injuries – Technical Report. Committee on Child Abuse and Neglect. Pediatrics 108: 206–210
American Academy of Pediatrics (AAP) (2009) Christian CW, Block R and the Committee on Child Abuse and Neglect: Abusive Head Trauma in Infants and Children. Policy Statement. Pediatrics 123: 1409–1411. http://pediatrics.aappublications.org/content/123/5/1409
AAP (American Academy of Pediatrics) & Levin AV, Christian CW (2010) The Eye Examination in the Evaluation of Child Abuse. Pediatrics 126: 376–380
Alexander RC, Levitt CJ, Smith WL (2001) Abusive head trauma. In: Reece RM, Ludwig S (eds). Child abuse – Medical diagnosis and management. 2nd ed. Lippincott Williams & Wilkins, Philadelphia Baltimore New York London. S 47–80
Bajanowski T, Neuen-Jacob E, Schubries M, Zweihoff R (2008) Nichtakzidentelles Schädel-Hirn-Trauma und Schütteltrauma. Rechtsmedizin 18: 23–28
Barlow KM, Thomson E, Johnson D, Minns RA (2005) Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy. Pediatrics 116: e174–185
Binenbaum G, Mirza-George N, Christian CW, Forbes BJ (2009) Odds of abuse associated with retinal hemorrhages in children suspected of child abuse. Journal of AAPOS 13: 268–72
Binenbaum G, Christian CW, Ichord RN, Ying GS, Simon MA, Romero K, Pollock AN, Forbes BJ (2013) Retinal hemorrhage and brain injury patterns on diffusion-weighted magnetic resonance imaging in children with head trauma. Journal of AAPOS 17: 603–608
Bhardwaj G, Chowdhury V, Jacobs MB et al. (2010) A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma. Ophthalmology 117: 983–992
Case ME (2008) Inflicted traumatic brain injury in infants and young children. Brain Pathol 18: 571–582
Chadwick DL, Bertocci G, Castillo E, Frasier L, Guenther E, Hansen K, Herman B, Krous H (2008) Annual risk of death resulting from short falls among young children: Less than l in l million. Pediatrics 121: 1213–1224
Choudhary AK, Ishak R, Zacharia TT, Dias MS (2014) Imaging of spinal injury in abusive head trauma, a retrospective study. Pediatr Radiol 44: 1130–1140
Core Info (August 2014) Systematic Review Neurological Injuries. www.core-info.cardiff.ac.uk/reviews/neurological – Abruf 30.09.2015
Core Info (Januar 2015) Systematic Review Retinal Findings. www.core-info.cardiff.ac.uk/reviews/retinal – Abruf 30.09.2015
Core Info (November 2014) Systematic Review Spinal Injuries. www.core-info.cardiff.ac.uk/reviews/spinal – Abruf 30.09.2015
Debertin AS, Sperhake JP (2008) Untersuchung und Dokumentation des nichtakzidentellen Schädel-Hirn-Traumas im Säuglings- und Kleinkindalter. Rechtsmedizin 18: 17–22
Dias M (2011) The case for shaking. In: Jenny C (ed) Child Abuse and Neglect: Diagnosis, Treatment and Evidence. Elsevier Saunders, St.Louis; S 364–372
Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R (1987) The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66: 409–415
Feldman KW, Bethel R, Shugerman RP et al. (2001) The cause of infant and toddler subdural hemorrhage: A prospective study. Pediatrics 108: 636–646
Franke I, Pingen A, Schiffmann H et al. (2014) Cardiopulmonary resuscitation (CPR)-related posterior rib fractures in neonates and infants following recommended changes in CPR techniques. Child Abuse Negl 38: 1267–1274
Geddes JF, Hackshaw AK, Vowles GH, Nichols CD, Whitwell HL (2001) Neuropathology of inflicted head injury in children I. Patterns of brain damage. Brain 124: 1290–1298
Gilliland MGE (1998) Interval duration between injury and severe symptoms in nonaccidental head trauma in infants and young children. J Forens Sci 43: 723–725
Greeley CS (2015) Abusive head trauma: A review of the evidence base. Am J Radiol 204: 967–973
Haseler LJ, Phil M, Arcinue E, Danielsen ER, Bluml S, Ross BD (1997) Evidence from proton magnetic resonance spectroscopy for a metabolic cascade of neuronal damage in Shaken Baby Syndrome. Pediatrics 99: 4–14
Herrmann B, Novak W, Pärtan G, Sperhake J (2008) Nichtakzidentelle Kopfverletzungen und Schütteltrauma-Syndrom. Klinische und pathophysiologische Aspekte. Monatsschr Kinderheilkd 156: 644–653
Hettler J, Greenes DS (2003) Can the initial history predict whether a child with a head injury has been abused? Pediatrics 111: 602–607
Hymel KP, Jenny C, Block RW (2002) Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: Addressing the forensic controversies. Child Maltreat 7: 329–348
Hymel KP, Armijo-Garcia V, Foster R et al. (2014) Validation of a Clinical Prediction Rule for Pediatric Abusive Head Trauma. Pediatrics 134: e1537–e1544
Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC (1999) Analysis of missed cases of abusive head trauma. JAMA 281: 621–626
Kaulfers A-M D, Backeljauw PF, Reifschneider K et al. (2010) Endocrine dysfunction following traumatic brain injury in children. J Pediatr 157: 894–899
Keenan H, Sege R (2003) Nomenclature, definitions, incidence and demographics of inflicted childhood neurotrauma. In: Reece RM, Nicholson CE (eds) Inflicted childhood neurotrauma. Proceedings of a conference, Bethesda, October 10–11, 2002. American Academy of Pediatrics. pp 3–16
Kemp AM, Rajaram S, Mann M, Tempest V, Farewell D, Gawne-Cain ML, Jaspan T and Maguire S and Welsh Child Protection Systematic Review Group (2009) What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clin Radiol 64: 473–483
Kemp A, Joshi A, Mann M, Tempest V, Liu A, Holden S, Maguire S (2010) What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review. Arch Dis Child 95: 355–360
Kochanek PM, Clark RSB, Ruppel RA, et al. (2000) Biochemical, cellular and molecular mechanisms in the evolution of secondary damage after severe traumatic brain injury in infants and children: lessons learned from the bedside. Pediatr Crit Care Med. 1, 4–19
Küker W, Schöning M, Krägeloh-Mann I, Nägele T (2006) Shaken baby syndrome. Bildgebende Methoden zur Erkennung einer schwerwiegenden Form der Säuglingsmisshandlung. Monatsschr Kinderheilkd 154: 659–668
Levin AV (2010) Retinal hemorrhage in abusive head trauma. Pediatrics 126: 961–970
Maguire S, Pickerd N, Farewell D, Mann M, Tempest V, Kemp AM (2009) Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review. Arch Dis Child 94: 860-867
Maguire SA, Kemp AM, Lumb RC, Farewell DM (2011) Estimating the Probability of Abusive Head Trauma: A Pooled Analysis. Pediatrics 128: e550–e564
Maguire SA, Watts PO, Shaw AD et al. (2013) Retinal haemorrhages and related findings in abusive and non-abusive head trauma: A systematic review. Eye 27: 28–36
Matschke J, Glatzel M (2008) Neuropathologische Begutachtung des nichtakzidentellen Schädel-Hirn-Traumas bei Säuglingen und Kleinkindern. Rechtsmedizin 18: 29–35
Matschke J, Voss J, Obi N et al. (2009) Nonaccidental head injury is the most common cause of subdural bleeding in infants < 1 year of age. Pediatrics 124: 1587–1594
Matschke J, Herrmann B, Sperhake J, Körber F, Bajanowski T, Glatzel M (2009) Das Schütteltrauma-Syndrom: Eine häufige Form des nicht akzidentellen Schädel-Hirn-Traumas im Säuglings- und Kleinkindesalter. Dtsch Arztebl Int 106: 211–217
Matschke J, Büttner A, Bergmann M et al. (2014) Encephalopathy and death in infants with abusive head trauma is due to hypoxic-ischemic injury following local brain trauma to vital brainstem centers. Int J Legal Med129: 105–114
Minns RA, Brown JK (2005) Neurological perspectives of non-accidental head injury and whiplash/shaken baby syndrome: An overview. In: Minns RA, Brown JK (eds) Shaking and other non-accidental head injuries in children. Clinics in Developmental Medicine No. 162. Cambridge University Press/Mac Keith Press. pp 1–105
Minns RA (2005) Shaken baby syndrome: Theoretical and evidential controversies. J Royal Coll of Phys of Edinburgh 35: 5–15
Narang S, Clarke J (2014) Abusive head trauma: Past, present, and future. J Child Neurol 29: 1747–56
Oehmichen M, Schleiss D, Pedal I et al. (2008) Shaken baby syndrome: re-examination of diffuse axonal injury as cause of death. Acta Neuropathol; 116: 317–29
Papa L, Ramia MN, Kelly JM et al. (2013) Systematic review of clinical research on biomarkers for pediatric traumatic brain injury. J Neurotrauma 30: 324–338
Piteau SJ, Ward MGK, Barrowman NJ, Plint AC (2012) Clinical and radiographic characteristics associated with abusive and nonabusive head trauma: A systematic review. Pediatrics 130: 315–323
Plunkett J (2001) Fatal pediatric head injuries caused by short-distance falls. Am J Forens Med Pathol 22: 1–12
Püschel K, Richter E (2008) Schütteltrauma. Rechtsmedizin 18: 53–55
Punt J, Bonshek RE, Jaspan T et al. (2004) The ›unified hypothesis‹ of Geddes et al. is not supported by the data. Pediatr Rehabil 7: 173–184
Runyan DK (2008) The challenges of assessing the incidence of inflicted traumatic brain injury: A world perspective. Am J Prev Med 34: s112–s115
Sieswerda-Hoogendoorn T, Boos S, Spivack B, Bilo RAC, van Rijn RR (2011) Abusive head trauma part 1: Clinical aspects. Eur J Pediatr 171: 415–23
Sieswerda-Hoogendoorn T, Bilo RAC, van Duurling LLBM, Karst WA et al. (2013) Abusive head trauma in young children in the Netherlands: Evidence for multiple incidents of abuse. Acta Paediatrica 102: e497–501
Sieswerda-Hoogendoorn T, Postema FAM, Verbaan D, Majoie CB, van Rijn RR (2014). Age determination of subdural hematomas with CT and MRI: A systematic review. Eur J Radiol 83: 1257–68
Sperhake J, Herrmann B (2008) Schütteltrauma (nicht akzidentelle Kopfverletzung). Aktuelle Kontroversen. Rechtsmedizin 18: 48–52
Thomsen H, von Klinggräff C, Rudolph J (1998) Forensische Aspekte beim »Schütteltrauma eines Säuglings«. Monatsschr Kinderheilkd 146: 875–878
Thyen U, Gerling I, Heinsohn-Krug M (2004) Intervention bei Schütteltrauma im Säuglingsalter – Konzepte und Kontroversen. In: Oehmichen M, Kaatsch HJ, Bosinski HAG (Hrsg.) Gewalt gegen Frauen und Kinder. Schmidt-Römhild, Lübeck, Research in Legal Medicine 32: S 201–221
Thyen U, Tegtmeyer FK (1991) Das Schütteltrauma des Säuglings – eine besondere Form der Kindesmisshandlung. Monatsschrift Kinderheilkunde 139: 292–296
Vavilala MS, Muangman S, Waitayawinyu P et al. (2007). Impaired cerebral autoregulation in infants and young children early after inflicted pediatric traumatic brain injury: a preliminary report. J. Neurotrauma 24, 87–96
Vinchon M, de Foort-Dhellemmes S, Desurmont M, Delestret I (2010) Confessed abuse versus witnessed accidents in infants: Comparison of clinical, radiological, and ophthalmological data in corroborated cases. Childs Nerv Syst 26: 637–645
Watts P and the Child Maltreatment Guideline Working Party of the and Royal College of Ophthalmologists and the Royal College of Paediatrics and Child Health (2013) Abusive head trauma and the eye in infancy. Eye, available on www.rcpch.ac.uk.
Wittschieber D, Karger B, Niederstadt T, Pfeiffer H, Hahnemann ML (2014) Subdural hygromas in abusive head trauma: Pathogenesis, diagnosis, and forensic implications. Am J Neuroradiol 36: 432–439
Wuerfel nee Tysiak E, Petersen D, Gottschalk S, Gerling I, Gliemroth J, Thyen U (2012) Progression of chronic subdural haematomas in an infant boy after abusive head trauma. Eur J Paediatr Neurol 16: 736–739
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Herrmann, B., Dettmeyer, R., Banaschak, S., Thyen, U. (2016). Misshandlungsbedingte Kopfverletzungen und Schütteltrauma-Syndrom. In: Kindesmisshandlung. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48844-7_3
Download citation
DOI: https://doi.org/10.1007/978-3-662-48844-7_3
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-48843-0
Online ISBN: 978-3-662-48844-7
eBook Packages: Medicine (German Language)