Many, if not most, instances of severe head trauma in infancy are attributable to child abuse. Thorough post mortem examination demonstrates upper cervical spinal cord lesions in a substantial fraction of infants who die of their head injuries,1 but these spinal cord injuries are seldom recognized ante mortem. Spinal column fractures have been described as incidental findings in the setting of child abuse, but they are seldom apparent clinically.2 Spinal cord injury without spinal fracture and without head injury is a rare presentation of child abuse, and the true nature of this syndrome may escape recognition unless other characteristic signs of abuse are detected.

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