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Axonal injury and the neuropathology of shaken baby syndrome


We examined an autopsy series of 14 children with shaken baby syndrome (SBS) who lacked skull fracture. Evidence of axonal injury was sought using immunohistochemical stains for neurofilament, 68-kDa neurofilament and β-amyloid precursor protein (βAPP). βAPP-positive axons were present in the cerebral white matter of all cases of SBS but were also present in 6 of 7 children dying of non-traumatic hypoxic ischemic encephalopathy (HIE). Swollen axons were present in 11 of 14 cases of SBS and in 6 of 7 cases of HIE. βAPP-positive axons were present in both groups in the midbrain and medulla. The cervical spinal cord in SBS contained βAPP-positive axons in 7 of 11 cases; 5 of 7 contained swollen axons within the white matter tracts; in 2 immunoreactivity was localized to spinal nerve roots; in all 7 there was a predilection for staining at the glial head of the nerve root. Among cases of HIE, none showed abnormal axons or βAPP-positive reactivity in the cervical cord white matter. We conclude that cerebral axonal injury is common in SBS, and may be due in part to hypoxic/ischemic injury. Cervical cord injury is also common, and cannot be attributed to HIE. These findings corroborate suggestions that flexion-extension injury about the cervical spinal column may be important in the pathogenesis of SBS.

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Received: 20 October 1997 / Accepted 19 November 1997

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Shannon, P., Smith, C., Deck, J. et al. Axonal injury and the neuropathology of shaken baby syndrome. Acta Neuropathol 95, 625–631 (1998).

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  • Key words Shaken baby syndrome
  • Shaken infant
  • Axonal injury
  • β-Amyloid precursor protein