SQ24C50017 - [2025] EWHC 2078 (Fam)

Mr Jalloh indicates that P suffered a brain and spine injury characterised by subdural bleeds on both sides of the head, diffuse hypoxic-ischaemic injury, vertebral body fractures in the spine and possible subdural blood in the spine.

In the absence of any relevant underlying disorder, the injuries would have been caused by an episode of trauma and probably a mechanism that involves shaking.

The traumatic episode that caused the injuries would have probably been painful or distressing and, accordingly, P would have displayed an immediate change in behaviour, such as crying or irritability. However, this might not represent a significant change in behaviour if he was already crying and/or unsettled. Sometimes a crying infant will become quiet or be rendered unconscious following an episode of trauma. The evolution of symptoms after a traumatic event depends on the degree of encephalopathy, ranging from irritability, lethargy, and vomiting to seizures, apnoea, reduced consciousness and possible life-threatening collapse. P’s presentation was consistent with encephalopathy. Although an infant suffering encephalopathy would be unlikely to behave entirely normally, the signs can be relatively non-specific and a caregiver who has not witnessed an episode of trauma would not reasonably be expected to attribute the signs to a brain injury.

The likelihood is that P sustained an episode of trauma after the point at which the Court can determine that he was last completely well and, on balance, shortly before his presentation on 8 May 2024. No evidence could be found of a previous brain injury that might coincide with earlier episodes of trauma that caused fractures or bruising, but this does not preclude this possibility.

All the lesions on the brain imaging are consistent with a single episode of trauma.

Mr Jalloh was cross examined. He was asked whether the vertebral fracture could have been the result of P’s seizures, as has been recorded in some research papers. He said that this would only occur in adults because adults have much stronger muscle bulk and so the force generated by seizures is much greater.

He was absolutely clear that the brain injuries were not consistent with a birth related subdural haemorrhage. The MRI scan showed an acute change which would have occurred within 3-7 days of the “insult” and would be very unlikely to be birth related. Further there was no evidence that even if P had had birth related subdural bleeding that would then create a vulnerability for later haemorrhage. For any such mechanism there would have to be a subdural fluid collection and there is no evidence that that occurred.

Mr Jalloh’s conclusions therefore remained precisely the same as they had been in his written report.