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Richard Schroeder, Susan M Culican; Serendipitous insight into the pathophysiology of retinal hemorrhages in Shaken Baby Syndrome. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5514.
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© ARVO (1962-2015); The Authors (2016-present)
Multiple mechanisms have been proposed for the development of retinal hemorrhages in shaken baby syndrome (SBS) including vitreoretinal traction, increased intracranial pressure, and hypoxia. This case of SBS generates the hypothesis that retinal hypoxia and vitreoretinal traction play a lesser role in the development of retinal hemorrhages. We present a case report of a child with a history of unilateral optic nerve hypoplasia and threshold retinopathy of prematurity (ROP) who suffered abusive head trauma with retinal hemorrhages only in the contralateral eye that describes a natural experiment that advances the understanding of pathophysiology in SBS.
This patient was a female infant born prematurely at 26 weeks estimated gestational age. She was followed for ROP beginning at 6 weeks of age, at which time she was noted to have optic nerve hypoplasia (ONH) in the left eye. At age 14 weeks she developed unilateral threshold ROP in the left eye that required laser therapy. By 15 weeks of age the left eye was improving while the right had complete (normal) vascularization. At age 18 weeks at the follow up ROP exam, the child was found to have widespread retinal hemorrhages in the right eye only. Subsequent workup showed diffuse bruising, broken ribs, and an admission of abuse.
The finding of unilateral retinal hemorrhage with contralateral optic nerve hypoplasia strongly suggests that the hemorrhage did not occur from hypoxia because the eye with a history of worsened retinopathy of prematurity would have been more affected if this were the case. Additionally, vitreoretinal traction does not seem responsible as both eyes would have been affected equally. The case suggests that the retinal hemorrhages occurred predominantly because of increased intracranial pressure which was passed through the normal left optic nerve but not through the hypoplastic right nerve.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Retinal hemorrhages in the right eye
Optic nerve hypoplasia and plus disease in the left eye
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