Doctor's Notes

Physician: D r . R yan C hen. G ener al P hysician

Time: 6 / 9/ 2 0 15 8 :5 4 P M
Symptoms: Inf lamed head. S ome out er b r uising ar ound r ib
cage and b r uising on b ack of head. B ab y is conscious b ut
let har gic.

Patient:B r inley B oken

Gender: Female
Weight: 12 .7 pounds
Height: 3 1.2 inches
Father: K evin B oken

Other Notes: P ar ent s say t he b ab ysit t er had an epilept ic

convulsion while handling t he child. C hild is said t o have

Mother: K r ist in B oken

vomit ed.

Notes: 18 mont h old inf ant . N o

pr ior medical incident s.

Description and Further Notes:

U pon ob ser vat ion, B r inley seems t o b e in poor condit ion. N o b leeding in eye and no signs of
b lindness. T her e may b e b r ain damage, b ut a C T scan or M R I will b e necessar y t o make
cer t ain. X -R ay t o check f or b r oken r ib s or ot her b ones. Fur t her physical examinat ion t o
check f ur t her . S t or y aligns wit h S haken B ab y S yndr ome, and child ser vices must b e called
f or invest igat ion. C ould b e M eningit is. b ut it is doub t f ul.
- P hysical Examinat ion
- CT

S can

- M R I S can
- X -R ay
N ot e: call C hild P r ot ect ive S er vices

Diagnostic Test Results

P hysical Exam

Doctor's Notes
Physician: D r . R yan C hen, G ener al P hysician

point of impact . N o whiplash in t he neck.

B lood t est shows no signs of incr eased
whit e b lood cell count . N o out er b r oken

Time: 6 / 9/ 2 0 15 9:12 P M

t issue. P ulse, b lood pr essur e, and

Description: B ab y is let har gic and does not

t emper at ur e is nor mal. S haken B ab y

move much. D espit e my ef f or t s, t he b ab y

S yndr ome seems conclusive.

will not smile. B r eat hing is slowed due t o

Pulse: 12 0 b pm

let har gy. N o b leeding in eye and no signs

of b lindness. P upils ar e similar siz es, and

Blood Pressure: 94/ 6 2

r espond t o light . B r uising along r ib s 1-3 b y

Respiratory Rate: 16 b r eat hs per minut e

ar mpit r egions. S ome b r uising along t he

nor mal should b e ar ound 2 5

occipit al b one of t he skull, seems t o b e

Diagnostic Test Results

Frontal X- Ray of Ribs
Doctor's Notes
Physician: Nurse J osh Traubert
Time: 6/ 9/ 2015 9:28 PM
Description: There is no damage to the ribs.

Bones are still connected. Damage on chest is

superf icial. No f luids in lungs or signs of
pneumonia.. most probably not meningitis.

Diagnostic Test Results

Axial MRI Scan of Brain

Doctor's Notes
Physician: Dr. Akash Kaza, Neurologist
Time:

6/ 9/ 2015 9:42 PM

Subdural hemorrhaging in thefrontal

region of thebrain and along theright superficial
sideof thebrain.. Thereissomehemorrhaging in
theposterior regions. Permanent brain damageis
possible.. I mmediateaction isrecommended.
Description:

Diagnostic Test Results

Axial CT Sc an of Br ain
Doctor's Notes
Physician: Dr . Daniel Fr yer , Rad iologist
Time: 6/ 9/ 20 15 11:18 PM
Description: Subd ur al hemor r haging in t he
f r ont al r egion of t he br ain and along t he
p er ip her y. T her e is mor e p r essur e build up on
t he r ight sid e of t he br ain. Per manent br ain

d amage is possible. I mmed iat e ac t ion is

r ec ommend ed.

Conclusion
Findings seem to point to Shaken Baby Syndrome. In the
patient, it seems to have affected the nervous system as the
brain has been restricted by inflammation and hemorrhaging.
The circulatory system has seemed to have been affected as
there is internal bleeding along the ribs and in the skull.
Constriction of the brain causes lethargy, affecting the
muscular system. Respiratory system is affected by the
lethargy. and is presented as a slower rate of breathing.

Shaking of the baby causes the brain to impact the walls of the
skull. This may rupture blood vessels and cause hemorrhaging in
the brain. Furthermore, there may be bruising where the baby
was shook and damage at a point of impact if the baby fell or
was thrown. Sometimes the eyes may be affected,
distinguishable by blindness, bleeding in the eye, or retinal
damage. Bones may be broken from impact behavior may be
changed by brain swelling. The baby may be lethargic or
irritable. Other changes include a loss of appetite, lack of
smiling, seizures, blue skin tone, poor sucking or swallowing,
lack of appetite, and difficulty breathing. It is entirely caused by
environmental factors.

Pictures showing head trauma from SBS

Treat ment and Prognosis: In order

to treat the patient, surgical
measures must be taken to stop the
bleeding in the brain. It does not
seem to be a severe case of Shaken
Baby Syndrome, but it may worsen.
Brain damage during infancy may
or may not lead to permanent
damage. Little Brinley may later
develop blindness, mental
retardation, learning or speech

One medical intervention to prevent the

underlying cause is a doll that indicates the
effect of shaking baby syndrome. This doll
can be used to educate parents of the effects
of violent shaking on a baby's brain.
Other treatments include stress and anger
management for parents. Pills may be
prescribed to adults with short tempers.
difficulties, and maybe even cerebral
palsy. There does not seem to be a
chance of death, but some form of
developmental disorder is likely.

Citations

(2012, March 9). Retrieved June 10, 2015, from

http:/ / www.cdc.gov/ concussion/ HeadsUp/ sbs.html

All About SBS/ AHT. (n.d.). Retrieved June 10, 2015, from
http:/ / www.dontshake.org/ sbs.php?topNavID=3&subNavID=317

Hershberger, M. (2014, March 1). Abusive Head Trauma (Shaken Baby Syndrome). Retrieved June
10, 2015, from http:/ / kidshealth.org/ parent/ medical/ brain/ shaken.html

NINDS Shaken Baby Syndrome Information Page. (n.d.). Retrieved June 10, 2015, from
http:/ / www.ninds.nih.gov/ disorders/ shakenbaby/ shakenbaby.htm

Shaken Baby Syndrome-Topic Overview. (n.d.). Retrieved June 10, 2015, from
http:/ / www.webmd.com/ parenting/ baby/ tc/ shaken-baby-syndrome-topic-overview

Shaken baby syndrome: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved June 10, 2015, from
http:/ / www.nlm.nih.gov/ medlineplus/ ency/ article/ 007578.htm
The doctors on this case:
Dr. Ryan Chen, General Physician, a doctor that treats all sorts of ailments
Dr. Daniel Fryer, Radiologist, a doctor with knowledge to operate and read various scanning machines
Dr. Akash Kaza, Neurologist, a doctor that specializes in the brain
Nurse Josh Traubert, a doctor-in-training that also helps in nursing