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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