# Shaken Adult Syndrome: Defining a New Traumatic Entity with an Evidence-Based Approach

## TL;DR

This paper introduces Shaken Adult Syndrome, a new traumatic condition defined by specific injuries from rapid flexion-extension movements in adults.

## Contribution

The paper proposes a diagnostic framework for Shaken Adult Syndrome using a validated diagnostic triad and a flowchart for clinical and forensic use.

## Key findings

- The diagnostic triad for Shaken Adult Syndrome includes subdural hemorrhages, retinal hemorrhages, and encephalopathy.
- A diagnostic flowchart is proposed to identify SAS in both live patients and post-mortem cases.
- Microscopic brain and ocular examinations using immunomarkers can confirm SAS pathognomonic features.

## Abstract

Major traumas result from the application of multiple force components that, in adulthood, can lead to high mortality and morbidity. In forensic practice, pathological consequences arising from the rapid flexion–extension of an adult victim’s soma are observed, with typical intracranial and ophthalmological findings. The totality of these findings allows for a contribution to the definition of the Shaken Adult Syndrome (SAS). A comprehensive review, employing the PRISMA methodology, was conducted on international works pertaining to SAS. This resulted in the identification of six scientific papers, which were analyzed separately. It emerged that, for the diagnosis of SAS, the same diagnostic triad as Shaken Baby Syndrome is valid, comprising subdural hemorrhages, retinal hemorrhages, and encephalopathy. This syndrome appears to encompass a broad spectrum of pathological conditions, ranging from whiplash to diffuse axonal injury (DAI). At the conclusion of this work, we proposed a diagnostic flowchart that allows for suspected predictive diagnosis of SAS, both in live patients presenting to emergency medical services and in post-mortem cadavers. For this purpose, the collection of anamnesis and circumstantial data, the detection of external injuries, and the execution of cranial CT scans will be essential. Ultimately, microscopic examinations of the brain with specific immunomarkers and of ocular structures will enable the identification of pathognomonic findings for SAS.