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In cases where carers have been convicted of Shaken Baby Syndrome the infant is twice as likely to be male as female. A similar 2:1 overrepresentation of males exists in Benign Hydrocephalus of Infancy, also known as Normal Pressure Hydrocephalus (NPH). It has previously been shown that excessive intra-abdominal pressures, occurring in paroxysmal coughing, retching or vomiting, can be communicated to intracranial veins. It is proposed that the missing pressure in NPH is this transient cerebral venous hypertension, in particular that caused by violent retching and vomiting in pyloric stenosis which also shows a 2:1 M/F ratio. Distension of intra cranial veins and capillaries would temporarily increase brain volume which would stimulate the dura to signal suture growth to the dimensions occurring during, and just after, the transient pressure surge. The pressure surge in capillaries throughout the brain would force water out through their walls into the interstitium. This water would then diffuse out through the brain surface, producing subarachnoid collections. At higher pressures the capillary endothelial cell tight junctions would separate, exposing the porous basement membrane, through which proteins could escape. At higher pressures still, some capillaries and veins would burst, producing the symptoms of Shaken Baby Syndrome.

Is “Shaken Baby Syndrome” The Malignant Peak of A “Benign Hydrocephalus of Infancy” Iceberg?