Ocular repercussions of suspected abusive head trauma

Abstract

Purpose: To determine the ophthalmological findings in a case series of suspected abusive head trauma, as well as its sequels and treatment. Methods: We conducted a retrospective case series of patients under 1 year of age with suspected history of abusive head trauma caused by shaking, direct trauma, or with a clinical presentation of seizures due to encephalopathy, retinal hemorrhage, or any other systemic repercussions suggestive of the shaken baby syndrome. Results: The study included 8 subjects, of which 5 were male (62%) and 3 female (38%), with a mean age of 4.12 months (± 2 months). All of them were examined by the ophthalmology department. In 7 cases (87%), the reason for consultation was seizures. In 57% of the studied cases, the mother was the person who witnessed the symptoms. Rib, skull, tibia, acromion, and collarbone fractures were radiologically diagnosed on 4 (50%) patients. All patients (100%) had bilateral vitreoretinal involvement, including intraretinal hemorrhage (100%), vitreous hemorrhage (36%), and post-traumatic macular hole (21%). Vitrectomy was performed in 29%. Conclusions: The combination of subdural hemorrhage, retinal hemorrhage, and encephalopathy in subjects under 1 year of age is considered indicative of abusive, inflicted, or non-accidental head injury. While the triad cannot confirm the diagnosis of the shaken baby syndrome, these findings are highly suggestive especially due to the lack of other explanations consistent with the clinical findings. It is highly disputable whether this diagnostic triad can be used as a confirmatory tool for an abusive direct trauma, or both, and the legal consequences may be unsuspected.

An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse

“…On a more holistic level, most patients may demonstrate hemorrhage either at the subdural region or retina [23]. Retinal hemorrhage can be as common as 100%, according to a report describing findings from a Swedish cohort of SBS cases [25]. Similarly, Wright et al (2021), who explored visual complications in a series of 44 children (median age: 16 weeks), reported a high prevalence of subdural hemorrhage (98%) and retinal hemorrhage (93%) in the population under investigation [26].…”