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Optic Nerve Sheath and Retinal Hemorrhages Associated With the Shaken Baby Syndrome

Optic Nerve Sheath and Retinal Hemorrhages Associated With the Shaken Baby Syndrome Abstract • A 13-month-old child with the pathognomonic findings of the shaken baby syndrome died secondary to cerebellar herniation. Pathologic examination disclosed extensive intraocular, optic nerve sheath, and intracranial hemorrhages, despite a paucity of external signs of trauma. Many of the hemorrhages were old, suggesting that the child had experienced multiple episodes of trauma. Hemorrhages of the optic nerve sheaths have not been previously reported with the shaken baby syndrome but probably accompany this condition frequently. Our patient's ocular hemorrhages may have resulted from a sudden rise in intracranial pressure. References 1. Kempe GH, Silverman FN, Steele BF, et al: The battered-child syndrome . JAMA 1962;181:17-24.Crossref 2. Gilkes MJ, Mann TP: Fundi of battered babies . Lancet 1967;2:468.Crossref 3. Caffey J: The whiplash shaken infant syndrome: Manual shaking by the extremities with whiplash-induced intracranial and intraocular bleeding, linked with residual permanent brain damage and mental retardation . Pediatrics 1974; 54:396-402. 4. Zimmerman RA, Bilaniuk LT, Bruce D, et al: Computed tomography of craniocerebral injury in the abused child . Radiology 1979;130:687-691.Crossref 5. Ludwig S: Shaken baby syndrome: A review of 20 cases . Ann Emerg Med 1984;13:104-107.Crossref 6. Baum JD, Bulpitt CJ: Retinal and conjunctival hemorrhage in the newborn . Arch Dis Child 1970;45:344-349.Crossref 7. Sezen F: Retinal hemorrhages in newborn infants . Br J Ophthalmol 1970;55:248-253.Crossref 8. Harcourt B, Hopkins D: Permanent chorioretinal lesions in childhood of suspected traumatic origin . Trans Ophthalmol Soc UK 1973; 93:199-205. 9. Weidenthal DT, Levin DB: Retinal detachment in a battered infant . Am J Ophthalmol 1976; 81:725-727. 10. Harcourt B, Hopkins D: Ophthalmic manifestations of the battered-baby syndrome . Br Med J 1971;3:398-401.Crossref 11. Caffey J: On the theory and practice of shaking infants: Its potential residual effects of permanent brain damage and mental retardation . AJDC 1972;124:161-169. 12. Eisenbrey AB: Retinal hemorrhages in the battered child . Child's Brain 1979;5:40-44. 13. Benstead JG: Shaking as a culpable cause of subdural hemorrhage in infants . Med Sci Law 1983;23:242-244. 14. Ober RR: Hemorrhagic retinopathy in infancy: A clinicopathologic report . J Pediatr Ophthalmol Strabismus 1980;17:17-20. 15. Lyle DJ, Stapp JP, Button RR: Ophthalmologic hydrostatic pressure syndrome . Am J Ophthalmol 1957;44:652-656. 16. Marr WG, Marr EG: Some observations on Purtscher's disease: Traumatic retinal angiopathy . Am J Ophthalmol 1962;54:693-705. 17. Kelley JS: Purtscher's retinopathy related to chest compression by safety belts . Am J Ophthalmol 1972;74:278-283. 18. Burton TC: Unilateral Purtscher's retinopathy . Ophthalmology 1980;87:1096-1105.Crossref 19. Duane TD: Valsalva hemorrhagic retinopathy . Am J Ophthalmol 1973;75:637-642. 20. Tomasi LG, Rosman NP: Purtscher retinopathy in the battered child syndrome . AJDC 1975;129:1335-1337. 21. Hollenhorst RW, Stein HA: Ocular signs and prognosis in subdural and subarachnoid bleeding in young children . Arch Ophthalmol 1958;60:187-192.Crossref 22. Walsh FB, Hoyt WF: Clinical Neuro-ophthalmology . Baltimore, Williams & Wilkins Co, 1969, vol 3, p 2348. 23. Muller PJ, Deck JHN: Intraocular and optic nerve sheath hemorrhage in cases of sudden intracranial hypertension . J Neurosurg 1974; 41:160-166.Crossref 24. Walsh FB, Hedges TR: Optic nerve sheath hemorrhage . Am J Ophthalmol 1951;34:509-527. 25. Hayreh S: Pathogenesis of occlusion of the central retinal vessels . Am J Ophthalmol 1971; 72:998-1011. 26. Oliver JE: Microcephaly following baby battering and shaking . Br Med J 1975;2:262-264.Crossref 27. Frank Y, Zimmerman R, Leeds NMD: Neurological manifestations in abused children who have been shaken . Dev Med Child Neurol 1985; 27:312-316.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Optic Nerve Sheath and Retinal Hemorrhages Associated With the Shaken Baby Syndrome

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1986.01050220103037
Publisher site
See Article on Publisher Site

Abstract

Abstract • A 13-month-old child with the pathognomonic findings of the shaken baby syndrome died secondary to cerebellar herniation. Pathologic examination disclosed extensive intraocular, optic nerve sheath, and intracranial hemorrhages, despite a paucity of external signs of trauma. Many of the hemorrhages were old, suggesting that the child had experienced multiple episodes of trauma. Hemorrhages of the optic nerve sheaths have not been previously reported with the shaken baby syndrome but probably accompany this condition frequently. Our patient's ocular hemorrhages may have resulted from a sudden rise in intracranial pressure. References 1. Kempe GH, Silverman FN, Steele BF, et al: The battered-child syndrome . JAMA 1962;181:17-24.Crossref 2. Gilkes MJ, Mann TP: Fundi of battered babies . Lancet 1967;2:468.Crossref 3. Caffey J: The whiplash shaken infant syndrome: Manual shaking by the extremities with whiplash-induced intracranial and intraocular bleeding, linked with residual permanent brain damage and mental retardation . Pediatrics 1974; 54:396-402. 4. Zimmerman RA, Bilaniuk LT, Bruce D, et al: Computed tomography of craniocerebral injury in the abused child . Radiology 1979;130:687-691.Crossref 5. Ludwig S: Shaken baby syndrome: A review of 20 cases . Ann Emerg Med 1984;13:104-107.Crossref 6. Baum JD, Bulpitt CJ: Retinal and conjunctival hemorrhage in the newborn . Arch Dis Child 1970;45:344-349.Crossref 7. Sezen F: Retinal hemorrhages in newborn infants . Br J Ophthalmol 1970;55:248-253.Crossref 8. Harcourt B, Hopkins D: Permanent chorioretinal lesions in childhood of suspected traumatic origin . Trans Ophthalmol Soc UK 1973; 93:199-205. 9. Weidenthal DT, Levin DB: Retinal detachment in a battered infant . Am J Ophthalmol 1976; 81:725-727. 10. Harcourt B, Hopkins D: Ophthalmic manifestations of the battered-baby syndrome . Br Med J 1971;3:398-401.Crossref 11. Caffey J: On the theory and practice of shaking infants: Its potential residual effects of permanent brain damage and mental retardation . AJDC 1972;124:161-169. 12. Eisenbrey AB: Retinal hemorrhages in the battered child . Child's Brain 1979;5:40-44. 13. Benstead JG: Shaking as a culpable cause of subdural hemorrhage in infants . Med Sci Law 1983;23:242-244. 14. Ober RR: Hemorrhagic retinopathy in infancy: A clinicopathologic report . J Pediatr Ophthalmol Strabismus 1980;17:17-20. 15. Lyle DJ, Stapp JP, Button RR: Ophthalmologic hydrostatic pressure syndrome . Am J Ophthalmol 1957;44:652-656. 16. Marr WG, Marr EG: Some observations on Purtscher's disease: Traumatic retinal angiopathy . Am J Ophthalmol 1962;54:693-705. 17. Kelley JS: Purtscher's retinopathy related to chest compression by safety belts . Am J Ophthalmol 1972;74:278-283. 18. Burton TC: Unilateral Purtscher's retinopathy . Ophthalmology 1980;87:1096-1105.Crossref 19. Duane TD: Valsalva hemorrhagic retinopathy . Am J Ophthalmol 1973;75:637-642. 20. Tomasi LG, Rosman NP: Purtscher retinopathy in the battered child syndrome . AJDC 1975;129:1335-1337. 21. Hollenhorst RW, Stein HA: Ocular signs and prognosis in subdural and subarachnoid bleeding in young children . Arch Ophthalmol 1958;60:187-192.Crossref 22. Walsh FB, Hoyt WF: Clinical Neuro-ophthalmology . Baltimore, Williams & Wilkins Co, 1969, vol 3, p 2348. 23. Muller PJ, Deck JHN: Intraocular and optic nerve sheath hemorrhage in cases of sudden intracranial hypertension . J Neurosurg 1974; 41:160-166.Crossref 24. Walsh FB, Hedges TR: Optic nerve sheath hemorrhage . Am J Ophthalmol 1951;34:509-527. 25. Hayreh S: Pathogenesis of occlusion of the central retinal vessels . Am J Ophthalmol 1971; 72:998-1011. 26. Oliver JE: Microcephaly following baby battering and shaking . Br Med J 1975;2:262-264.Crossref 27. Frank Y, Zimmerman R, Leeds NMD: Neurological manifestations in abused children who have been shaken . Dev Med Child Neurol 1985; 27:312-316.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Oct 1, 1986

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