La datation des lésions neurologiques centrales des bébés secoués. Discussion sur la sémiologie radiologique

The semiology of Shaken Baby syndrome is now well known. A cerebral tomodensitography (TDM) is typically the first diagnostic employed due to the nature of the clinical and neurological symptoms. Contrary to magnetic resonance imaging (MRI), TDM is accessible, has a short acquisition time and simple interpretation, although the former offers better analysis of radioanatomic semiology. The violent action of a person evoked by the term “shaken baby” represents a breach of the law, and therefore is of interest to the magistrate. It is the responsibility of the forensic doctors to report in terms of “certified injuries” and “compatibility” with the injury mechanisms used by legal investigations. This compatibility can be inferred starting from the hypothesized day of the violent acts. However, the delay between the investigative facts and the injuries are of no concern to the doctor in charge of the patient, and therefore does not lead to a strategy of complimentary exams. On the other hand, this delay is of the utmost interest to the magistrate, and therefore to the forensic doctor. The question is, what kind of clinical or radiologic element can the forensic doctor use to date the noticed brain injuries? With what reliabilty ? Do common investigations strategies exist that are both useful for the physician and the forensic doctor?