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Whiplash shaking syndrome: retinal hemorrhages and computerized axial tomography of the brain
Insights
Pediatricians must suspect whiplash shaking injury in infants presenting with seizures and subtle signs. Prompt, dilated retinal examinations are crucial for diagnosing this form of child abuse, often missed by physicians.
Area of Science:
- Pediatrics
- Ophthalmology
- Forensic Medicine
Background:
- Whiplash shaking injury in infants often presents with subtle external signs.
- Retinal hemorrhages, particularly pale-centered ones, are key indicators of abusive head trauma.
- Early diagnosis is critical but challenging due to the subtlety of symptoms.
Purpose of the Study:
- To present cases of whiplash shaking injury in infants.
- To highlight the diagnostic importance of retinal examinations.
- To emphasize the need for increased physician awareness and suspicion.
Main Methods:
- Case series presentation of three infants with whiplash shaking injury.
- Detailed clinical examination including fundoscopy after pupillary dilation.
- Diagnostic confirmation through skeletal surveys and social history.
- Comparison with computerized axial tomography (C.T.) findings.
Main Results:
- All infants presented with seizures and minimal external injury.
- Extensive, pale-centered retinal hemorrhages were discovered upon dilated examination.
- C.T. scans showed minimal inter-hemispheric bleeding, contrasting with the retinal findings.
- A fourth case illustrated diagnostic challenges when shaking is claimed for resuscitation.
Conclusions:
- Whiplash shaking syndrome requires heightened physician awareness and suspicion.
- Dilated fundoscopy is essential for detecting subtle but critical retinal hemorrhages.
- This syndrome can be missed if thorough retinal examinations are not performed.
Abstract:
Three cases of whiplash shaking injury of infants are presented. All children presented with seizures and had minimal signs of external injury. Examination of the retina revealed extensive retinal hemorrhages. These were missed on initial examination and were only discovered after pupillary dilatation. The presence of these palecentered retinal hemorrhages suggested the diagnosis of child abuse and skeletal surveys and thorough social histories confirmed the diagnosis. Despite extensive retinal hemorrhages, computerized axial tomography (C.T.) scan showed minimal inter-hemispheric bleeding. In contrast to the "Battered Child Syndrome," all the findings in whiplash shaking syndrome of infants are subtle and demand an awareness, an index of suspicion and a thorough examination which may include extensive retinal examination following dilatation of the pupils. This latter examination is frequently not performed by family physicians and residents so that the syndrome may be missed. A fourth case is also discussed where shaking is admitted on initial presentation but said to be done for resuscitation. This poses an immense diagnostic dilemma to the pediatrician since in this case the child presented later with all the signs of physical abuse.