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Retinal findings

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Retinal findings were recorded in relation to laterality, number and extent of haemorrhages and layers of the retina involved, as follows:

 

Laterality of retinal haemorrhages

  • Comparative data showed the majority of abusive head trauma (AHT) cases were bilateral 2,3,5,7,10  in contrast to non-abusive head trauma (nAHT) where 0-8% of cases were bilateral 2,4,7,9,10
  • Studies detailing accidental trauma include:
    • Isolated case reports of bilateral retinal haemorrhages following severe crush injury or high fall 1,6,7,9

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References

  1. Agrawal S, Peters MJ, Adams GG, Pierce CM. Prevalence of retinal haemorrhages in critically ill children. Pediatrics. 2012;129(6):e1388-e1396 [Pubmed]

  2. Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168 [Pubmed]
  3. Buys YM, Levin AV, Enzenauer RW, Elder JE, Letourneau MA, Humphreys RP, Mian M, Morin JD. Retinal findings after head trauma in infants and young children. Ophthalmology. 1992;99(11):1718-1723 [Pubmed]
  4. Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108(3):636-646 [Pubmed]
  5. Haviland J, Russell RI. Outcome after severe non-accidental head injury. Archives of Disease in Childhood. 1997;77(6):504-507 [Pubmed]
  6. Lantz PE, Sinal SH, Stanton CA, Weaver RG Jr. Perimacular retinal folds from childhood head trauma. British Medical Journal. 2004;328(7442):754-756 [Pubmed]
  7. Minns RA, Jones PA, Tandon A, Fleck BW, Mulvihill AO, Elton RA. Prediction of inflicted brain injury in infants and children using retinal imaging. Pediatrics. 2012;130(5):e1227-34 [Pubmed]

  8. Moran K, Reddie I, Jacobs M. Severe haemorrhagic retinopathy and traumatic retinoschisis in a 2 year old infant, after an 11 metre fall onto concrete. Acta Paediatrica. 2008;97(suppl 459):149 Full article published: Reddie IC, Bhardwaj G, Dauber SL, Jacobs MB, Moran KT. Bilateral retinoschisis in a 2-year-old following a three-storey fall. Eye. 2010;24(8):1426-1427 [Pubmed citation only]
  9. Sturm V, Knecht PB, Landau K, Menke MN. Rare retinal haemorrhages in translational accidental head trauma in children. Eye. 2009;23(7):1535-41 [Pubmed]

  10. Trenchs V, Curcoy AI, Navarro R, Pou J. Subdural haematomas and physical abuse in the first two years of life. Pediatric Neurosurgery. 2007;43(5):352-357 [Pubmed]
  11. Watts P, Obi E. Retinal folds and retinoschisis in accidental and non-accidental head injury. Eye. 2008;22(12):1514-1516 [Pubmed]

Number of retinal haemorrhages

  • Comparative data identified that the majority of AHT cases had larger numbers of retinal haemorrhages in comparison to the accidental cases 1-3,8,9,10
  • Among the non-comparative literature 4-7,11 four case reports of non-abusive injury recorded cases with multiple retinal haemorrhages 4-6,11, of which three were crush injuries 5,6,11

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References

  1. Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168 [Pubmed]
  2. Buys YM, Levin AV, Enzenauer RW, Elder JE, Letourneau MA, Humphreys RP, Mian M, Morin JD. Retinal findings after head trauma in infants and young children. Ophthalmology. 1992;99(11):1718-1723 [Pubmed]
  3. Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108(3):636-646 [Pubmed]
  4. Gardner HB. A witnessed short fall mimicking presumed shaken baby syndrome (inflicted childhood neurotrauma). Pediatric Neurosurgery. 2007;43(5):433-435 [Pubmed]
  5. Gnanaraj L, Gilliland MGF, Yahya RR, Rutka JT, Drake J, Dirks P, Levin AV. Ocular manifestations of crush head injury in children. Eye. 2007;21(1):5-10 [Pubmed]
  6. Lueder GT, Turner JW, Paschall R. Perimacular retinal folds simulating nonaccidental injury in an infant. Archives of Ophthalmology. 2006;124(12):1782-1783 [Pubmed citation only]
  7. Madsen PH. Traumatic retinal angiopathy. Report of six cases of Purtscher's disease. Acta Ophthalmologica. 1965;43(6):776-786 [Pubmed citation only]
  8. Minns RA, Jones PA, Tandon A, Fleck BW, Mulvihill AO, Elton RA. Prediction of inflicted brain injury in infants and children using retinal imaging. Pediatrics. 2012;130(5):e1227-34 [Pubmed]

  9. Trenchs V, Curcoy AI, Navarro R, Pou J. Subdural haematomas and physical abuse in the first two years of life. Pediatric Neurosurgery. 2007;43(5):352-357 [Pubmed]
  10. Vinchon M, De Foort-Dhellemmes S, Desurmont M, Delestret I. Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases. Child's Nervous System. 2010;26(5):637-645. [Pubmed]

  11. Watts P, Obi E. Retinal folds and retinoschisis in accidental and non-accidental head injury. Eye. 2008;22(12):1514-1516 [Pubmed]

Extent of retinal haemorrhages

  • Few comparative studies recorded the extent of retinal haemorrhages; of those that did 1,5,6,8-10 the majority of AHT extended to the ora serrata, while very few nAHT cases did 5,6,9,10
  • Amongst the non-comparative nAHT studies, retinal haemorrhages were limited to the posterior pole in the majority 2-4,7

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References

  1. Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168 [Pubmed]
  2. Gardner HB. A witnessed short fall mimicking presumed shaken baby syndrome (inflicted childhood neurotrauma). Pediatric Neurosurgery. 2007;43(5):433-435 [Pubmed]
  3. Gnanaraj L, Gilliland MGF, Yahya RR, Rutka JT, Drake J, Dirks P, Levin AV. Ocular manifestations of crush head injury in children. Eye. 2007;21(1):5-10 [Pubmed]
  4. Madsen PH. Traumatic retinal angiopathy. Report of six cases of Purtscher's disease. Acta Ophthalmologica. 1965;43(6):776-786 [Pubmed citation only]
  5. Minns RA, Jones PA, Tandon A, Fleck BW, Mulvihill AO, Elton RA. Prediction of inflicted brain injury in infants and children using retinal imaging. Pediatrics. 2012;130(5):e1227-34 [Pubmed]

  6. Sturm V, Knecht PB, Landau K, Menke MN. Rare retinal haemorrhages in translational accidental head trauma in children. Eye. 2009;23(7):1535-41 [Pubmed]

  7. Trenchs V, Curcoy AI, Morales M, Serra A, Navarro R, Pou J. Retinal haemorrhages in head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age. Child's Nervous System. 2008;24(7):815-820 [Pubmed]
  8. Trenchs V, Curcoy AI, Navarro R, Pou J. Subdural haematomas and physical abuse in the first two years of life. Pediatric Neurosurgery. 2007;43(5):352-357 [Pubmed]
  9. Vinchon M, Defoort-Dhellemmes S, Desurmont M, Dhellemmes P. Accidental and nonaccidental head injuries in infants: a prospective study. Journal of Neurosurgery. 2005;102(4 Suppl):380-384 [Pubmed]
  10. Vinchon M, Defoort-Dhellemmes S, Noulé N, Duhem R, Dhellemmes P. Accidental or non-accidental brain injury in infants. Prospective study of 88 cases [French]. Presse Médicale. 2004;33(17):1174-1179 [Pubmed]

Retinal layer

  • Devising a summary of the retinal layer most involved was hampered by authors’ varying terminology
  • Among comparative studies, intraretinal haemorrhages predominated in both AHT and nAHT; except in one study which showed intraretinal haemorrhages to be more common in AHT 10; subretinal haemorrhages were only (or more commonly 10) recorded in AHT; preretinal haemorrhages were more common among AHT 2-4,7,10,12,15,17,18. A recent study of witnessed accidents versus confessed abuse noted more flame-shaped haemorrhages amongst nAHT 16
  • In one comparative study, only the abuse cases exhibited retinal haemorrhages, all of which were multilayered including preretinal and intraretinal and subhyaloid 13
  • In one non-comparative nAHT study detailing the layer, 4/7 cases were multi-layered with the precise layer not defined 1
  • From non-comparative nAHT literature, intraretinal haemorrhage remained the commonest location but with preretinal noted 5,6,8,9,11,14,19

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References

  1. Agrawal S, Peters MJ, Adams GG, Pierce CM. Prevalence of retinal haemorrhages in critically ill children. Pediatrics. 2012;129(6):e1388-e1396 [Pubmed]

  2. Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168 [Pubmed]
  3. Buys YM, Levin AV, Enzenauer RW, Elder JE, Letourneau MA, Humphreys RP, Mian M, Morin JD. Retinal findings after head trauma in infants and young children. Ophthalmology. 1992;99(11):1718-1723 [Pubmed]
  4. Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108(3):636-646 [Pubmed]
  5. Forbes BJ, Cox M, Christian CW. Retinal hemorrhages in patients with epidural hematomas. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2008;12(2):177-180 [Pubmed]
  6. Gnanaraj L, Gilliland MGF, Yahya RR, Rutka JT, Drake J, Dirks P, Levin AV. Ocular manifestations of crush head injury in children. Eye. 2007;21(1):5-10 [Pubmed]
  7. Haviland J, Russell RI. Outcome after severe non-accidental head injury. Archives of Disease in Childhood. 1997;77(6):504-507 [Pubmed]
  8. Lantz PE, Sinal SH, Stanton CA, Weaver RG Jr. Perimacular retinal folds from childhood head trauma. British Medical Journal. 2004;328(7442):754-756 [Pubmed]
  9. Lueder GT, Turner JW, Paschall R. Perimacular retinal folds simulating nonaccidental injury in an infant. Archives of Ophthalmology. 2006;124(12):1782-1783 [Pubmed citation only]
  10. Minns RA, Jones PA, Tandon A, Fleck BW, Mulvihill AO, Elton RA. Prediction of inflicted brain injury in infants and children using retinal imaging. Pediatrics. 2012;130(5):e1227-34 [Pubmed]

  11. Moran K, Reddie I, Jacobs M. Severe haemorrhagic retinopathy and traumatic retinoschisis in a 2 year old infant, after an 11 metre fall onto concrete. Acta Paediatrica. 2008;97(suppl 459):149 Full article published: Reddie IC, Bhardwaj G, Dauber SL, Jacobs MB, Moran KT. Bilateral retinoschisis in a 2-year-old following a three-storey fall. Eye. 2010;24(8):1426-1427 [Pubmed citation only]
  12. Pierre-Kahn V, Roche O, Dureau P, Uteza Y, Renier D, Pierre-Kahn A, Dufier JL. Ophthalmologic findings in suspected child abuse victims with subdural hematomas. Ophthalmology. 2003;110(9):1718-1723 [Pubmed]
  13. Sturm V, Knecht PB, Landau K, Menke MN. Rare retinal haemorrhages in translational accidental head trauma in children. Eye. 2009;23(7):1535-41 [Pubmed]

  14. Trenchs V, Curcoy AI, Morales M, Serra A, Navarro R, Pou J. Retinal haemorrhages in head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age. Child's Nervous System. 2008;24(7):815-820 [Pubmed]
  15. Trenchs V, Curcoy AI, Navarro R, Pou J. Subdural haematomas and physical abuse in the first two years of life. Pediatric Neurosurgery. 2007;43(5):352-357 [Pubmed]
  16. Vinchon M, De Foort-Dhellemmes S, Desurmont M, Delestret I. Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases. Child's Nervous System. 2010;26(5):637-645. [Pubmed]

  17. Vinchon M, Defoort-Dhellemmes S, Desurmont M, Dhellemmes P. Accidental and nonaccidental head injuries in infants: a prospective study. Journal of Neurosurgery. 2005;102(4 Suppl):380-384 [Pubmed]
  18. Vinchon M, Defoort-Dhellemmes S, Noulé N, Duhem R, Dhellemmes P. Accidental or non-accidental brain injury in infants. Prospective study of 88 cases [French]. Presse Médicale. 2004;33(17):1174-1179 [Pubmed]
  19. Watts P, Obi E. Retinal folds and retinoschisis in accidental and non-accidental head injury. Eye. 2008;22(12):1514-1516 [Pubmed]

Additional retinal features

  • Numerous additional retinal features were recorded 1-62
  • Of note, schisis cavities were recorded in up to ten-times as many AHT cases 42,43,44,50,60,62 as nAHT cases 37,43,45,60

  • Retinal folds are more common amongst AHT cases 2,10,13,19,25,31,42,43,52,60,62 than nAHT cases 33,37,60

  • Vitreous haemorrhages are more common amongst AHT cases 2,5,8-11,13,19,20,24,31,34,35,39-43,59 than nAHT cases 14,37,43

  • Two cases of subhyaloid haemorrhage were recorded in AHT cases. One required surgery, the other had cleared by two months 23
  • Few cases of epiretinal membrane 15, retinal tears 34,36,39,61 and macular hole 3,39 were recorded and these were exclusively amongst AHT cases

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References

  1. Agner C, Weig SG. Arterial dissection and stroke following child abuse: case report and review of the literature. Childs Nervous System. 2005;21(5):416-420 [Pubmed]
  2. Arlotti SA, Forbes BJ, Dias MS, Bonsall DJ. Unilateral retinal hemorrhages in shaken baby syndrome. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2007;11(2):175-178 [Pubmed]
  3. Arnold RW. Macular hole without hemorrhages and shaken baby syndrome: practical medicolegal documentation of children's eye trauma. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2003;40(6):355-357 [Pubmed citation only]
  4. Barcenilla AI, de la Maza VT, Cuevas NC, Ballus MM, Castanera AS, Fernandez JP. When a funduscopic examination is the clue of maltreatment diagnostic. Pediatric Emergency Care. 2006;22(7):495-496 [Pubmed]
  5. Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168 [Pubmed]
  6. Becker JC, Liersch R, Tautz C, Schlueter B, Andler W. Shaken baby syndrome: report on four pairs of twins. Child Abuse and Neglect. 1998;22(9):931-937 [Pubmed]
  7. Biron D, Shelton D. Perpetrator accounts in infant abusive head trauma brought about by a shaking event. Child Abuse and Neglect. 2005;29(12):1347-1358 [Pubmed]
  8. Brown SM, Bradley JC. Hemorrhagic posterior vitreous detachment without intraretinal hemorrhage in a shaken infant. Archives of Ophthalmology. 2007;125(9):1301 [Pubmed citation only]
  9. Buys YM, Levin AV, Enzenauer RW, Elder JE, Letourneau MA, Humphreys RP, Mian M, Morin JD. Retinal findings after head trauma in infants and young children. Ophthalmology. 1992;99(11):1718-1723 [Pubmed]
  10. Caputo G, de Haller R, Metge F, Dureau, P. Ischemic retinopathy and neovascular proliferation secondary to shaken baby syndrome. Retina. 2008;28(3 suppl):S42-46 [Pubmed]
  11. Carter JE, McCormick AQ. Whiplash shaking syndrome: retinal hemorrhages and computerized axial tomography of the brain. Child Abuse and Neglect. 1983;7(3):279-286 [Pubmed]
  12. Christian CW, Taylor AA, Hertle RW, Duhaime AC. Retinal hemorrhages caused by accidental household trauma. Journal of Pediatrics. 1999;135(1):125-127 [Pubmed]
  13. Drack AV, Petronio J, Capone A. Unilateral retinal hemorrhages in documented cases of child abuse. American Journal of Ophthalmology. 1999;128(3):340-344 [Pubmed]
  14. Duhaime AC, Christian C, Armonda R, Hunter J, Hertle R. Disappearing subdural hematomas in children. Pediatric Neurosurgery. 1996;25(3):116-122 [Pubmed]
  15. Ells AL, Kherani A, Lee D. Epiretinal membrane formation is a late manifestation of shaken baby syndrome. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2003;7(3):223-225 [Pubmed]
  16. Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108(3):636-646 [Pubmed]
  17. Forbes BJ, Cox M, Christian CW. Retinal hemorrhages in patients with epidural hematomas. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2008;12(2):177-180 [Pubmed]
  18. Gardner HB. A witnessed short fall mimicking presumed shaken baby syndrome (inflicted childhood neurotrauma). Pediatric Neurosurgery. 2007;43(5):433-435 [Pubmed]
  19. Gaynon MW, Koh K, Marmor MF, Frankel LR. Retinal folds in the shaken baby syndrome. American Journal of Ophthalmology. 1988;106(4):423-425 [Pubmed]
  20. Giangiacomo J, Barkett KJ. Ophthalmoscopic findings in occult child abuse. Journal of Pediatric Ophthalmology and Strabismus. 1985;22(6):234-237 [Pubmed]
  21. Gilles EE, Nelson MD Jr. Cerebral complications of nonaccidental head injury in childhood. Pediatric Neurology. 1998;19(2):119-128 [Pubmed]
  22. Gnanaraj L, Gilliland MGF, Yahya RR, Rutka JT, Drake J, Dirks P, Levin AV. Ocular manifestations of crush head injury in children. Eye. 2007;21(1):5-10 [Pubmed]
  23. Goldenberg DT, Wu D, Capone A Jr, Drenser KA, Trese MT. Nonaccidental trauma and peripheral retinal nonperfusion. Ophthalmology. 2010;117(3):561-566. [Pubmed]

  24. Greenwald MJ, Weiss A, Oesterle CS, Friendly DS. Traumatic retinoschisis in battered babies. Ophthalmology. 1986;93(5):618-625 [Pubmed]
  25. Han DP, Wilkinson WS. Late ophthalmic manifestations of the shaken baby syndrome. Journal of Pediatric Ophthalmology and Strabismus. 1990;27(6):299-303 [Pubmed]
  26. Haviland J, Russell RI. Outcome after severe non-accidental head injury. Archives of Disease in Childhood. 1997;77(6):504-507 [Pubmed]
  27. Healey K, Schrading W. A case of shaken baby syndrome with unilateral retinal hemorrhage with no associated intracranial hemorrhage. American Journal of Emergency Medicine. 2006;24(5):616-617 [Pubmed citation only]
  28. Helfer RE, Scheurer SL, Alexander R, Reed J,Slovis TL. Trauma to the bones of small infants from passive exercise: a factor in the etiology of child abuse. Journal of Pediatrics. 1984;104(1):47-50 [Pubmed]
  29. Hylton C, Goldberg MF. Images in clinical medicine. Circumpapillary retinal ridge in the shaken-baby syndrome. New England Journal of Medicine. 2004;351(2):170 [Pubmed]
  30. Kapoor S, Schiffman J, Tang R, Kiang E, Li H, Woodward J. The significance of white-centered retinal hemorrhages in the shaken baby syndrome. Pediatric Emergency Care. 1997;13(3):183-185 [Pubmed]
  31. Kivlin JD, Simons KB, Lazoritz S, Ruttum MS. Shaken baby syndrome. Ophthalmology. 2000;107(7):1246-1254 [Pubmed]
  32. Lambert SR, Johnson TE, Hoyt CS. Optic nerve sheath and retinal hemorrhages associated with the shaken baby syndrome. Archives of Ophthalmology. 1986;104(10):1509-1512 [Pubmed]
  33. Lantz PE, Sinal SH, Stanton CA, Weaver RG Jr. Perimacular retinal folds from childhood head trauma. British Medical Journal. 2004;328(7442):754-756 [Pubmed]
  34. Lash SC, Williams CP, Luff AJ, Hodgkins PR. 360 degree giant retinal tear as a result of presumed non-accidental injury. British Journal of Ophthalmology. 2004;88(1):155 [Pubmed citation only]
  35. Levin AV, Magnusson MR, Rafto SE, Zimmerman RA. Shaken baby syndrome diagnosed by magnetic resonance imaging. Pediatric Emergency Care. 1989;5(3):181-186 [Pubmed]
  36. Levy I, Wysenbeek YS, Nitzan M, Nissenkorn I, Lerman-Sagle T, Steinherz R. Occult ocular damage as a leading sign in the battered child syndrome. Metabolic, Pediatric and Systemic Ophthalmology. 1990;13(1):20-22 [Pubmed]
  37. Lueder GT, Turner JW, Paschall R. Perimacular retinal folds simulating nonaccidental injury in an infant. Archives of Ophthalmology. 2006;124(12):1782-1783 [Pubmed citation only]
  38. Madsen PH. Traumatic retinal angiopathy. Report of six cases of Purtscher's disease. Acta Ophthalmologica. 1965;43(6):776-786 [Pubmed citation only]
  39. Matthews GP, Das A. Dense vitreous hemorrhages predict poor visual and neurological prognosis in infants with shaken baby syndrome. Journal of Pediatric Ophthalmology and Strabismus. 1996;33(4):260-265 [Pubmed]
  40. McCabe CF, Donahue SP. Prognostic indicators for vision and mortality in shaken baby syndrome. Archives of Ophthalmology. 2000;118(3):373-377 [Pubmed]
  41. Mierisch RF, Frasier LD, Braddock SR, Giangiacomo J, Berkenbosch JW. Retinal hemorrhages in an 8-year-old child: an uncommon presentation of abusive injury. Pediatric Emergency Care. 2004;20(2):118-120 [Pubmed]
  42. Mills M. Funduscopic lesions associated with mortality in shaken baby syndrome. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 1998;2(2):67-71 [Pubmed]
  43. Minns RA, Jones PA, Tandon A, Fleck BW, Mulvihill AO, Elton RA. Prediction of inflicted brain injury in infants and children using retinal imaging. Pediatrics. 2012;130(5):e1227-34 [Pubmed]

  44. Morad Y, Kim YM, Armstrong DC, Huyer D, Mian M, Levin AV. Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome. American Journal of Ophthalmology. 2002;134(3):354-359 [Pubmed]
  45. Moran K, Reddie I, Jacobs M. Severe haemorrhagic retinopathy and traumatic retinoschisis in a 2 year old infant, after an 11 metre fall onto concrete. Acta Paediatrica. 2008;97(suppl 459):149 Full article published: Reddie IC, Bhardwaj G, Dauber SL, Jacobs MB, Moran KT. Bilateral retinoschisis in a 2-year-old following a three-storey fall. Eye. 2010;24(8):1426-1427 [Pubmed citation only]
  46. Ogershok PR, Jaynes ME, Hogg JP. Delayed papilledema and hydrocephalus associated with shaking impact syndrome. Clinical Pediatrics. 2001;40(6):351-354 [Pubmed citation only]
  47. Oral R, Yagmur F, Nashelsky M, Turkmen M, Kirby P. Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse. Pediatric Emergency Care. 2008;24(12):816-821 [Pubmed]
  48. Pierre-Kahn V, Roche O, Dureau P, Uteza Y, Renier D, Pierre-Kahn A, Dufier JL. Ophthalmologic findings in suspected child abuse victims with subdural hematomas. Ophthalmology. 2003;110(9):1718-1723 [Pubmed]
  49. Pitetti RD, Maffei F, Chang K, Hickey R, Berger R. Pierce MC. Prevalence of retinal hemorrhages and child abuse in children who present with an apparent life-threatening event. Pediatrics. 2002;110(3):557-562 [Pubmed]
  50. Salehi-Had H, Brandt JD, Rosas AJ, Rogers KK. Findings in older children with abusive head injury: does shaken-child syndrome exist? Pediatrics. 2006;117(5):e1039-1044 [Pubmed]
  51. Schloff S, Mullaney PB, Armstrong DC, Simantirakis E, Humphreys RP, Myseros JS, Buncic JR, Levin AV. Retinal findings in children with intracranial hemorrhage. Ophthalmology. 2002;109(8):1472-1476 [Pubmed]
  52. Sturm V, Landau K, Menke MN. Optical coherence tomography findings in Shaken Baby syndrome. American Journal of Ophthalmology. 2008;146(3):363-368 [Pubmed]
  53. Trenchs V, Curcoy AI, Morales M, Serra A, Navarro R, Pou J. Retinal haemorrhages in head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age. Child's Nervous System. 2008;24(7):815-820 [Pubmed]
  54. Trenchs V, Curcoy AI, Navarro R, Pou J. Subdural haematomas and physical abuse in the first two years of life. Pediatric Neurosurgery. 2007;43(5):352-357 [Pubmed]
  55. Vinchon M, Defoort-Dhellemmes S, Desurmont M, Dhellemmes P. Accidental and nonaccidental head injuries in infants: a prospective study. Journal of Neurosurgery. 2005;102(4 Suppl):380-384 [Pubmed]
  56. Vinchon M, Defoort-Dhellemmes S, Noulé N, Duhem R, Dhellemmes P. Accidental or non-accidental brain injury in infants. Prospective study of 88 cases [French]. Presse Médicale. 2004;33(17):1174-1179 [Pubmed]
  57. Vinchon M, Noizet O, Defoort-Dhellemmes S, Soto-Ares G, Dhellemmes P. Infantile subdural hematomas due to traffic accidents. Pediatric Neurosurgery. 2002;37(5):245-253 [Pubmed]
  58. Wahl NG, Woodall BN. Hypothermia in shaken infant syndrome. Pediatric Emergency Care. 1995;11(4):233-234 [Pubmed citation only]
  59. Waterhouse W, Enzenauer RW, Parmley VC. Inflammatory orbital tumor as an ocular sign of a battered child. American Journal of Ophthalmology. 1992;114(4):510-512 [Pubmed citation only]
  60. Watts P, Obi E. Retinal folds and retinoschisis in accidental and non-accidental head injury. Eye. 2008;22(12):1514-1516 [Pubmed]
  61. Weidenthal DT, Levin DB. Retinal detachment in a battered infant. American Journal of Ophthalmology. 1976;81(6):725-727 [Pubmed]
  62. Weis A, Kodsi SR, Rubin SE, Esernio-Jenssen D, Ferrone PJ, McCormick SA. Subretinal hemorrhage masquerading as a hemorrhagic choroidal detachment in a case of nonaccidental trauma. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2007;11(6):616-617 [Pubmed]

Retinal findings amongst perpetrator admitted AHT cases

  • One comparative study addressed retinal findings amongst perpetrator admitted AHT and independently witnessed nAHT 3, two other studies were non-comparative AHT cases 1,2
  • In the comparative study 84% of AHT cases had retinal haemorrhages versus 17% of nAHT. Amongst those, 56.8% of AHT had severe retinal haemorrhages versus 2.27% of nAHT 3
  • The majority of cases included bilateral, multiple retinal haemorrhages 1,2. It was notable however that despite perpetrator admitted injury, 3/17 cases were unilateral while 2/17 had less than five retinal haemorrhages per eye 2

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References

  1. Bell E, Shouldice M, Levin AV. Abusive head trauma: A perpetrator confesses. Child Abuse and Neglect. 2011;35(1):74-77 [Pubmed]

  2. Margolin EA, Dev LS, Trobe JD. Prevalence of retinal hemorrhages in perpetrator-confessed cases of abusive head trauma. Archives of Ophthalmology. 2010;128(6):795 [Pubmed citation only]

  3. Vinchon M, De Foort-Dhellemmes S, Desurmont M, Delestret I. Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological, and ophthalmological data in corroborated cases. Child's Nervous System. 2010;26(5):637-645. [Pubmed]

 

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