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[Traction retinal detachment, optic atrophy, apallic syndrome after shaking trauma in an infant]
1Augenklinik der Kliniken der Stadt Köln/Merheim, Pädiatrisch-Ophthalmologisches Zentrum, Kinderkrankenhaus der Kliniken der Stadt Köln/Riehl.
Insights
Ophthalmological findings like retinal hemorrhages in infants can signal non-accidental injuries, such as shaken baby syndrome. Prompt recognition is crucial for early intervention and better outcomes.
Area of Science:
- Pediatric ophthalmology
- Child abuse detection
Background:
- Ophthalmological examinations are critical for children suspected of shaken baby syndrome or battered child syndrome.
- Retinal and epiretinal hemorrhages are key indicators of non-accidental injuries in infants.
Observation:
- A 6-week-old infant presented with altered consciousness, respiratory distress, and a subdural hematoma.
- Ophthalmoscopy revealed extensive retinal hemorrhages and optic disc edema.
- The infant later developed optic atrophy, neovascularization, and tractional retinal detachment.
Findings:
- Non-accidental trauma can lead to severe ocular complications beyond initial presentation.
- The progression of retinal and optic nerve damage highlights the long-term consequences of abusive head trauma.
Implications:
- Retinal hemorrhages in infants with unexplained trauma warrant high suspicion for shaken baby syndrome.
- Ophthalmologists play a vital role in identifying non-accidental injuries and advocating for further investigation.
Introduction:
Ophthalmological examinations are important in children with suspected shaken baby and/or battered child syndrome. Retinal and epiretinal haemorrhages can indicate non-accidental injuries. We observed a case of extensive retinal hemorrhages, edema of the optic disc followed by development of optic atrophy, neovascularisation and tractional retinal detachment over the course of months.
Case Report:
A 6-week-old infant with no history of systemic disease or trauma was admitted to the children's hospital because of a disorder of consciousness, respiratory insufficiency, taut fontanel and dilated pupils with sluggish reaction to light. A subdural haematoma was diagnosed. Ophthalmological examination showed no signs of trauma in the anterior segment. Ophthalmoscopy revealed extensive retinal haemorrhages and swollen optic nerve heads. During the next months optic atrophy, subretinal fibrosis at the posterior pole, neovascularisation at the optic disc and non-rhegmatogenous retinal detachment developed. The child is in a persistent vegetative state.
Discussion:
Non-accidental injuries can cause direct trauma and indirect traumatic sequelae. Retinal haemorrhages, especially in conjunction with unexplained trauma or changes of consciousness should arouse suspicion of shaken baby syndrome. The ophthalmologist should emphasize this and strongly recommend further investigation if not previously undertaken.