Retinal Hemorrhage Predicts Neurologic Injury in the Shaken Baby Syndrome

Wilkinson, W. Scott

doi:10.1001/archopht.1989.01070020546037

Cited by 118 publications

(47 citation statements)

References 13 publications

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“…Although there are many possibilities for the cause of the abnormal visual function in these children (eg, injury to the occipital cortex, optic radiation, optic nerve, and retina), in most cases, it is attributable to injury to the cortex and optic radiation. 27,28 Additional studies on the long-term visual outcome are necessary as the extent of these problems are likely to have been previously underestimated, and when they occur, they un- …”

Section: Discussionsupporting

confidence: 40%

Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy

Barlow

Thomson

Johnson³

et al. 2005

Pediatrics

301

175

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ABSTRACT.Objective. There is limited information regarding the long-term outcome of inflicted traumatic brain injury (TBI), including shaken infant syndrome. The purpose of this study was to describe the long-term neurologic, behavioral, and cognitive sequelae seen in this population.Methods. A cross-sectional and prospective longitudinal study was conducted of 25 children with inflicted TBI in Scotland between 1980 and 1999. After consent was obtained, neurologic and cognitive examinations were performed on all participants and sequentially in the prospective cohort. Two global outcome measures were used: Glasgow Outcome Score (GOS) and Seshia's outcome score. Cognitive outcome was assessed using the Bayley Scales of Infant Development, British Ability Scales, and the Vineland Adaptive Behavior Scales.Results. The mean length of follow-up was 59 months. A total of 68% of survivors were abnormal on follow-up, 36% had severe difficulties and were totally dependant, 16% had moderate difficulties, and 16% had mild difficulties on follow-up. A wide range of neurologic sequelae were seen, including motor deficits (60%), visual deficits (48%), epilepsy (20%), speech and language abnormalities (64%), and behavioral problems (52%). There was a wide range of cognitive abilities: the mean psychomotor index, 69.9 (SD: ؎25.

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Section: Discussionsupporting

confidence: 40%

Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy

Barlow

Thomson

Johnson³

et al. 2005

Pediatrics

301

175

View full text Add to dashboard Cite

show abstract

“…11,12,14,15,17,18,47,56,61,64,66 (Vinchon raw data set)13, 16,67 Data set 2: Highly selected case series/studies with o10 subjects each. 3,[5][6][7][48][49][50][51][52][53][54][55][57][58][59][60]62,63,65,68 Data set 3: Both of the above data sets combined.…”

Section: Resultsmentioning

confidence: 47%

Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

Maguire

Watts

Shaw

et al. 2012

Eye

162

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Aim To report the retinal signs that distinguish abusive head trauma (AHT) from non-abusive head trauma (nAHT). Methods A systematic review of literature, 1950-2009, was conducted with standardised critical appraisal. Inclusion criteria were a strict confirmation of the aetiology, children aged o11 years and details of an examination conducted by an ophthalmologist. Post mortem data, organic disease of eye, and inadequate examinations were excluded. A multivariate logistic regression analysis was conducted to determine odds ratios (OR) and probabilities for AHT. Results Of the 62 included studies, 13 provided prevalence data (998 children, 504 AHT). Overall, retinal haemorrhages (RH) were found in 78% of AHT vs 5% of nAHT. In a child with head trauma and RH, the OR that this is AHT is 14.7 (95% confidence intervals 6.39, 33.62) and the probability of abuse is 91%. Where recorded, RH were bilateral in 83% of AHT compared with 8.3% in nAHT. RH were numerous in AHT, and few in nAHT located in the posterior pole, with only 10% extending to periphery. True prevalence of additional features, for example, retinal folds, could not be determined. Conclusions Our systematic review confirms that although certain patterns of RH were far commoner in AHT, namely large numbers of RH in both the eyes, present in all layers of the retina, and extension into the periphery, there was no retinal sign that was unique to abusive injury. RH are rare in accidental trauma and, when present, are predominantly unilateral, few in number and in the posterior pole.

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“…[42] Another possibility, by analogy with subdural hemorrhage, is that a direct acceleration-deceleration insult to the globe causes shear stresses between the ocular tissues with differing mechanical properties; this mechanism of injury is especially prominent in autopsy cases. [15,22] Because a gradation of inflicted ocular injury corresponds to the gradation of severity of the associated intracranial injury, [15,43] different mechanisms likely come into play in response to varying degrees of violence.…”

Section: Discussionmentioning

confidence: 41%

A pitfall in the diagnosis of child abuse: external hydrocephalus, subdural hematoma, and retinal hemorrhages

Piatt¹

1999

FOC

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External hydrocephalus has been associated with subdural hematomas in infancy, and the hematomas have been noted to be secondary to minor trauma or have even been described as spontaneous. The author reports the case of an infant with external hydrocephalus who developed retinal as well as subdural hemorrhages after sustaining a minor head injury. Although retinal hemorrhage in infancy has been considered virtually pathognomonic of child abuse, in the setting of external hydrocephalus a more cautious interpretation may be appropriate.

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Retinal Hemorrhage Predicts Neurologic Injury in the Shaken Baby Syndrome

Cited by 118 publications

References 13 publications

Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy

Late Neurologic and Cognitive Sequelae of Inflicted Traumatic Brain Injury in Infancy

Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review

A pitfall in the diagnosis of child abuse: external hydrocephalus, subdural hematoma, and retinal hemorrhages

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