Warning: This post contains mention of child abuse.
In October 2003, Julie Baumer took her infant nephew Philipp to the hospital. The boy presented with lethargy, irritability, vomiting, and unwillingness to eat. Doctors performed a CT scan and saw that the baby had a skull fracture and subdural and retinal hemorrhaging. The bleeding was so great that his fontanelle (the soft spot where a baby’s skull is forming) was bulging (Bazelon, 2011). Philipp was also dehydrated and septic. Due to the extensive amount of time taken before an emergency operation, Philipp suffered severe brain damage; he survived the ordeal, but lives with cerebral palsy (Bazelon, 2011). For Julie Baumer, the worst was yet to come.
Baumer was charged with first-degree child abuse. Doctors testified that the baby had experienced blunt force trauma and Shaken Baby Syndrome (SBS) at Baumer’s hands. In 2005, she was convicted and sentenced to 10-15 years in prison.
In 2010, thanks to the Michigan Innocence Clinic, Baumer was granted a new trial. This time, six experts testified that the baby had been suffering from cerebral venous sinus thrombosis (CVST), the effects of which can appear similar to SBS. Vaslow (2021) states that “for infants presenting with subdural hemorrhage, retinal hemorrhage, and neurological decline the ‘consensus’ opinion is that this constellation represents child abuse and that cerebral venous sinus thrombosis … is a false mimic…. [but] this conclusion is false for a subset of infants with no evidence of spinal, external head, or body injury.”
CVST is known by many names, including cerebral sinovenous thrombosis and cerebral venous thrombosis (CVT). Whatever you call it, this is a stroke characterized by a blood clot in a cerebral blood vessel (DynaMed). Within the pediatric population, newborns account for 30-50% of cases (Ichord, 2017). Although the clinical presentation in children can vary, pediatric patients will typically present with headache, vomiting, and depressed mental status (DynaMed). Other symptoms may include seizures and otalgia (ear pain).
In newborns, acute systemic illness is the primary risk factor for CVST (Ichord, 2017). In children, the predominant cause of CVST is acute head or neck infections, such as mastoiditis; chronic diseases such as nephrotic syndrome or inflammatory bowel disease are also possible causes. In order to diagnose CVST, neuroimaging must be used, typically an MRI (Vaslow, 2021).
What about Philipp’s skull fracture? This was a “red herring” in the case which at first seemed like evidence of child abuse, but with further analysis, doctors were able to determine that this was an older injury attributable to Philipp’s difficult birth (Bazelon, 2011).
Julie Baumer was acquitted of all charges, but some – including the family who ended up adopting Philipp – still believe she is guilty. Although it is not the legal responsibility of a doctor to determine a caretaker’s innocence, medical professionals are required to document injuries objectively and report suspected abuse to authorities (U.S. Department of Justice, 2014). Therefore, research into and awareness of the differences between SBS and CVST is necessary to keep young children safe and healthy and to keep innocent caregivers out of prison.
Do you know of another interesting true crime case with medical connections? Email Rachel Brill at rgbrill@gwu.edu.
References and Further Reading
Bazelon, Emily. Shaken-Baby Syndrome Faces New Questions in Court. The New York Times Magazine. February 2, 2011. https://www.nytimes.com/2011/02/06/magazine/06baby-t.html?pagewanted=all&_r=0
Brown SD. Ethical challenges in child abuse: what is the harm of a misdiagnosis? Pediatr Radiol. 2021 May;51(6):1070-1075. doi: 10.1007/s00247-020-04845-4. https://link-springer-com.proxygw.wrlc.org/article/10.1007/s00247-020-04845-4
Denzel, Stephanie. Julie Baumer. The National Registry of Exonerations. Updated February 27, 2020. https://www.law.umich.edu/special/exoneration/Pages/casedetail.aspx?caseid=3017
DynaMed. Cerebral Venous Thrombosis (CVT) in Children. https://proxygw.wrlc.org/login?url=https://www.dynamed.com/condition/cerebral-venous-thrombosis-cvt-in-children Accessed May 26, 2022.
Ichord R. Cerebral sinovenous thrombosis. Frontiers in pediatrics. 2017;5:163-163. doi:10.3389/fped.2017.00163 https://www.frontiersin.org/articles/10.3389/fped.2017.00163/full
U.S. Department of Justice. (2014). Recognizing When a Child’s Injury or Illness Is Caused by Abuse. https://permanent.fdlp.gov/gpo84798/243908.pdf
Vaslow DF. Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants. Neuroradiol J. 2022 Feb;35(1):53-66. doi: 10.1177/19714009211026904. https://proxygw.wrlc.org/login?url=https://journals.sagepub.com/doi/pdf/10.1177/19714009211026904
Vinchon M, Noulé N, Karnoub MA. The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news. Childs Nerv Syst. 2022 Jan;38(1):133-145. doi: 10.1007/s00381-021-05357-8. https://link.springer.com/content/pdf/10.1007/s00381-021-05357-8.pdf
