Abstract
Purpose: :
The characteristic findings that suggest inflicted head trauma in so-called shaken baby syndrome consist of subdural, and/or subarachnoidal hemorrhages, extensive retinal hemorrhages and encephalopathy in infants. Two major theories on the cause of retinal hemorrhages exist:The first postulates raised retinal venous pressure due to sudden increases in chest or head pressure. The second theory of vitreoretinal traction from repeated acceleration-deceleration postulates a direct mechanical effect of the shaking or impact itself. We studied optical coherence tomography (OCT) features associated with shaken baby syndrome in an attempt to gain new insight into the pathophysiology of this phenomenon.
Methods: :
Three infants with typical findings of shaken baby syndrome were referred to our institution within a year (11/2006 - 10/2007) for ocular examination. Their ages ranged from four to eight months. Dilated fundus biomicroscopy,photography and OCT were performed in all cases.
Results: :
In all infants bilateral numerous multilayered retinal hemorrhages, extending to the ora serrata, were present. In one case bilateral perimacular folds had occurred. OCT confirmed pre-retinal, intra-retinal, subretinal hemorrhages and perimacular folds. Moreover, OCT revealed vitreoretinal traction and suspected hemorrhagic macular retinoschisis in two infants.
Conclusions: :
To our knowledge so far OCT findings were not reported in shaken baby syndrome. OCT confirmed the multilayered macular hemorrhages and provided valuable additional information about the ocular pathology in these patients. Vitreoretinal membrane formation seen in OCT could support the pathophysiological theory of a direct mechanical effect itself. OCT suggested small hemorrhagic macular retinoschisis in one patient without perimacular folds. Perimacular folds and hemorrhagic macular retinoschisis are regarded highly specific for shaken baby syndrome and indicate poor visual outcome. Thus OCT might be of both diagnostic and prognostic value in shaken baby syndrome.
Keywords: imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • trauma • retina