Abusive Head Trauma - Shaken Baby Syndrome
Abusive head trauma (AHT) – Shaken baby syndrome
Shaken baby syndrome presents as retinal haemorrhages and
cotton-wool spots in an abused infant:
·
Violent shaking.
·
Direct eye, head, or
chest trauma.
·
Choking.
Clinical picture:
·
Retinal haemorrhages.
·
Rarely:
o Subhyaloid hemorrhage (haemorrhagic macular cyst.)
o Circular perimacular folds.
o
Secondary
retinoschisis - Predominantly macular foveoschisis.
·
Vitreous hemorrhage.
·
Papilledema.
·
Anterior segment
findings: Anisocoria, poor pupillary reaction, and mydriasis often indicate
severe concurrent CNS injury.
·
subdural or
subarachnoid hemorrhage.
·
|
Intraretinal, subretinal, pretinal, and
vitreous haemorrhages may occur following either vaginal or caesarean birth
in over one-third of newborns. These haemorrhages tend to resolve quickly
and are generally gone by 1 month following birth. They can mimic retinal
haemorrhages seen in the shaken baby syndrome and should be considered in
the differential diagnosis. |
·
Hypoxic-ischemic brain
injury.
·
Skeletal/ cutaneous
injuries.
Ocular injury may be present in up to 30–40% of abused
children, while 75% of children with ocular manifestations exhibit associated
brain injury.
Differential diagnosis of retinal manifestations:
·
Terson’s syndrome.
·
Purtscher’s
retinopathy.
·
Central retinal vein
occlusion.
loss, which may be secondary to:
·
Macular scarring.
·
Vitreous hemorrhage.
·
Retinal detachment.
·
Amblyopia.
Retinal reattachment surgery or vitrectomy for vitreous hemorrhage
may be beneficial.
Late changes:
Nonspecific.
Permanent visual impairment is frequent, with central visual impairment related to the
brain injury is the most common cause.
·
Amblyopia caused by visual
deprivation due to prolonged vitreous hemorrhage may occur.
·
Optic disc pallor;
optic atrophy.
·
Nonspecific retinal
pigmentary changes.
·
Macular hole.
·
Vitreous opacities.
·
Retinal thinning.
·
High myopia.
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