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The Significance of Macrocephaly or Enlarging Head Circumference in Infants With the Triad: Further Evidence of Mimics of Shaken Baby Syndrome

Miller, David BS*; Barnes, Patrick MD; Miller, Marvin MD

The American Journal of Forensic Medicine and Pathology: June 2015 - Volume 36 - Issue 2 - p 111–120
doi: 10.1097/PAF.0000000000000152
Original Articles

Infants with the triad (neurologic dysfunction, subdural hematoma [SDH], and retinal hemorrhage) are often diagnosed as victims of shaken baby syndrome. Medical conditions/predisposing factors to developing the triad are often dismissed: short falls, birth-related SDH that enlarges, macrocephaly, sinus/cortical vein thrombosis, and others. Six infants with the triad are described in which child abuse was diagnosed, but parents denied wrongdoing. All 6 had either macrocephaly or enlarging head circumference, which suggested medical explanations. Three infants incurred short falls, 1 had a difficult delivery in which there was likely a rebleed of a birth-related SDH, 1 had a spontaneous SDH associated with increased extra-axial fluid spaces, and 1 had a sinus thrombosis. Following legal proceedings, all 6 infants were returned to their parents, and there has been no child maltreatment in follow-up, suggesting child abuse never happened. The results indicate that alternative medical explanations for causing the triad should be considered and that macrocephaly or an enlarging head circumference raises the possibility of a medical explanation.

From the *Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX; †Department of Radiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Palo Alto, CA; and ‡Department of Pediatrics, Obstetrics/Gynecology, and Biomedical Engineering, Wright State University Boonshoft School of Medicine, Dayton, OH.

Manuscript received December 9, 2014; accepted February 26, 2015.

The authors report no conflict of interest.

Reprints: Marvin Miller, MD, Department of Medical Genetics, Dayton Children’s Hospital, 1 Children’s Plaza, Dayton, OH 45404. E-mail:

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© 2015 by Lippincott Williams & Wilkins.