A US radiologist has told the Circuit Criminal Court that brain scans from a ten-month-old baby show the possibility of a prior injury not consistent with baby shaking.
Dr Julie Mack was giving evidence for the defence by video-link in the trial of 34-year-old childminder Sandra Higgins of Drumgola Wood, Cavan, who denies causing serious harm to the baby at her home on 28 March 2012.
Dr Mack, who specialises in paediatric radiology, said CT and MRI scans of the baby's brain show the possibility of a "re- bleeding" of an earlier injury or pre-existing problem.
She said the scans show a small amount of blood, which was more consistent with the baby having received a bump to the head, rather than a tearing of larger blood vessels associated with baby shaking.
She said the scans also showed evidence of a possible chronic condition, which could have been weeks old and a healing membrane could have incurred a spontaneous bleed.
Dr Mack said the small amount of blood was not enough to suggest the tearing of a larger blood vessel.
Due to the area it was in it was more likely to have been the result of a bump on the head, which was also evident from the scans, she said.
The scans were insufficiently detailed to time any possible impact that could have happened in the previous seven days, she said.
During cross-examination prosecuting counsel Sean Gillane said she was coming from the perspective of having a "fixed view" about baby-shaking syndrome, which was contrary to the vast majority of medical experts.
Dr Mack said she did not accept the standard view about baby- shaking but disagreed this was contrary to the view of vast majority.
She said she absolutely disagreed with what she was taught in medical school.
"It is a standard view, most people believe and are taught that when you shake a baby the veins break into the subdural space. I absolutely disagree with it," she said.
It was put to her that this was the view of the vast majority of medical experts. She said she disagreed it was the view of the vast majority and that fewer people now held the view.
"Your view is unshakeable and you are not for turning," Mr Gillane said.
He said she seemed to know very little about this individual case and had not received the range of reports from various doctors who treated the baby.
"The reason shaking has been brought up here is because of the images. Had this brain not had subdural haemorrhaging then I don't think shaking would have been brought up," Dr Mack said.
Mr Gillane said it would be wrong for a physician to rush to judgement and say an injury is accidental or historic without considering all the information.
"I did not say it was accidental I said the evidence on the imaging is associated with impact. I cannot say if it was accidental or inflicted." Dr Mack said.
Scans show classic sign of baby shaking
Dr Christopher Hobbs, a UK based consultant paediatrician, who reviewed the findings of doctors here said he would have drawn the same conclusions of non-accidental brain injury.
He said some of the injuries represented "a classic text book case of baby shaking".
Dr Hobbs, who specialises in child maltreatment, said he would have raised serious concerns about the bruising alone.
He said the distribution of the bruises on the baby would have been extremely concerning because of the baby's age.
The number and sites were very unusual such as bruising on the padded area of the buttock.
A cluster of bruises on a baby's back along with two broken ribs was extremely unusual and normally associated with compression or baby shaking.
He said it was a "classic text book case of baby shaking". He also said bruising to the ear was very worrying.
He said the triad of finding of a brain bleed, retinal haemorrhaging and retinal detachment were all indicative of baby shaking but that the term baby shaking syndrome could also include some impact.
"The term has shifted from baby shaking syndrome to non-accidental head trauma. We don't know the precise mechanism, all we know is there is a level of violence involved".
A study he carried out in 2005 of 186 infants with subdural haematoma identified 106 as having suffered from abuse and only seven were accidental injuries.
The remainder were due to other factors such as disease or birth injury.
He also said there was no good evidence of "lucid interval" after a head injury such as this.
"It makes no sense to say that she was shaken the day before because her brain was damaged," he said.
During cross-examination, Dr Hobbs said shaken baby syndrome was more than a hypothesis and was well established over many years.
He said he believed the onset of symptoms was the most accurate way to establish the time of the injury.
It was put to him by defence counsel Remy Farrell that this could not be conclusive.
Dr Hobbs said it was not conclusive but it was the best guide they had. He said there was no reason to think that the brain would be perfectly all right and then suddenly become unwell.
He said the change in the baby will be an indicator of the time of the injury.
He did not believe there was any evidence to support a theory of a lucid interval or latent period between a head injury and the onset of symptoms.
"All we can say is that we don't think there is a period after the child is shaken when they are just fine and then the next day they collapse, we don't think that is what happens and we don't have any sound evidence for that."
Mr Farrell put it to him that there was "stark and bitter" disagreement among medical professionals about shaken baby syndrome.
Dr Hobbs said he had not experienced this but would not be surprised if there was because it was an emotive subject and doctors fall out just like other people.
Professor of Pediatrics at Temple Street Children's University Hospital Alf Nicholson said the constellation of injuries "was really quite consistent with abusive head trauma or shaken baby syndrome".
He said Temple Street had a lot of experience with these cases.
"It is a very difficult issue, a very emotive issue. I've been down this road many times."
Consultant radiologist at Cavan General Hospital Dr Val Gough said the CT scan of the baby's brain showed a subdural haemorrhage which was a high indicator of suspicion of a non-accidental injury.
He said he would not agree with Dr Julie Mack's view that the bleed was due to a chronic or previous condition.
