A Dundee baby who required life-saving surgery for a brain injury was likely a victim of “sustained, forceful shaking”, a doctor has claimed.
Dr Michael Jackson said the injuries suffered by the four-month-old child were consistent with “abusive head trauma”.
A consultant neurosurgeon who performed an emergency operation on the boy at Ninewells Hospital said the child could have died within hours.
The claims were made during the trial of Marc Lannen, 34, who is accused of attempting to murder the boy by shaking him in August 2018.
Jurors at the High Court in Dundee heard the baby suffered a subdural hematoma, in which blood collects between the skull and the surface of the brain.
The court heard claims Lannen fed the child without issue at around 5pm before calling his mother at 6.30pm to voice concerns about the boy’s condition.
An ambulance was called for at around 6.55pm at the insistence of Lannen’s mother and the youngster was rushed to Ninewells Hospital.
‘No way injuries accidental’
The child’s mother – who cannot be identified for legal reasons – claims Lannen initially told her he had suffered a seizure but later said he had fallen from a couch.
After the successful operation at Ninewells, the child was taken to the Royal Hospital for Sick Children in Edinburgh, where Dr Jackson works as a consultant paediatric radiologist.
Following a review of a CT scan at Ninewells, Dr Jackson believed there was “no way” the injuries sustained could have been accidental.
He said: “To my mind, the features are suggestive of a shaking episode.
“There is a lack of soft tissue swelling and no skull fracture.
“There is no way it could have been caused by an accidental mechanism.
“We are talking about a sustained episode of significant, forceful shaking.
“It’s not a momentary lapse of annoyance, it would be a sustained episode to produce the amount of blood we are seeing.”
Dr Jackson said his opinion was based on the “widespread distribution” of blood, the lack of bruising or physical injuries on the child and retinal haemorrhaging that could be seen in an MRI scan, something the doctor said was rare.
Advocate depute Leanne McQuillan suggested scenarios of the injuries being caused by the child falling from a sofa, being distressed in a bouncer or a spontaneous subdural hematoma.
“Absolutely not,” Dr Jackson replied.
“There are some rare-ish reports of subdural hematomas occurring spontaneously but they are typically small volume in nature.
“There’s really no resemblance between those cases and what we have seen with (the child).”
‘Horrific’ shift in baby’s brain
When the child arrived at Ninewells, he was described as having a dilated left pupil, struggling to breathe and with his eyes rolling back, having suffered a “prolonged” seizure of around 55 minutes.
Consultant neurosurgeon Dr Kismet Hossain-Ibrahim performed surgery immediately after seeing an “enormous” clot in the CT scan, taken at around 8.30pm.
Dr Ibrahim told the court: “It was clear to me that this patient did not need observation but immediate evacuation to save his life.”
He told the court the “horrific” shift from the midline in the child’s brain was around 2cm – a shift of around 5mm or more usually requires emergency surgery.
The neurosurgeon said, without an operation: “The most likely scenario, given the degree of midline shift, would have been death.”
He said the child’s head injury was similar to that of a road traffic accident victim and believed it was a result of a “single event” and “most likely… a severe blunt head injury”.
The jury was told how the child had no previous instances of trauma and no previous seizures.
He was described in earlier evidence as “totally fine”, with Lannen telling police, despite having a chesty cold the baby was “laughing away” and eating as normal.
Opening day’s evidence
On the first day of the trial jurors heard the child’s mother tell how she went for a day out in Dundee, leaving her son in Lannen’s care.
She said he initially told her the child had suffered a seizure but about a year later, said he had fallen from a couch, prompting her to call police.
Lannen’s mother Carol McQuillan, told how she was called by her son and arrived to find the child “very lethargic and very still”.
She said: “There was a sob every now and again. He was quite pale, it was like his eyes weren’t open properly.”
His mother told the court the child had a second operation and now aged six, requires additional support but is “improving slowly but surely”.
The trial continues.
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