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Published on: August 25, 2014
[Eye manifestations of shaken baby syndrome. A case presentation]
B Poepel1, V Seiberth, M C Knorz
1Augenklinik, Klinikum Mannheim, Fakultät für Klinische Medizin, Ruprecht-Karls-Universität Heidelberg, Mannheim.
Insights
Shaken baby syndrome, a form of child abuse, can cause severe bleeding in the eyes and brain. Early ophthalmological exams are crucial for diagnosing this condition, even before other signs appear.
Area of Science:
- Pediatric ophthalmology
- Child abuse research
- Neurology
Background:
- Shaken baby syndrome (SBS) is a severe form of child abuse.
- Intracranial hemorrhages, retinal, and vitreous bleeding are common in SBS.
- Fundus bleeding in SBS can mimic Terson syndrome.
Observation:
- A 4-month-old infant presented with seizures and extensive fundus bleeding.
- Ocular findings and seizures were disproportionate to minor external trauma.
- Cranial CT scans revealed progressive intracerebral bleeding and brain atrophy.
Findings:
- Intraocular hemorrhages in SBS may precede clinical and radiological signs of subdural hematoma.
- Fundus bleeding resolved during the observation period.
- The case highlights the diagnostic importance of fundus bleeding in suspected SBS.
Implications:
- Ophthalmological examination is critical for early detection of SBS.
- Fundus bleeding can be the primary indicator of SBS in the absence of other trauma evidence.
- Prompt diagnosis through fundus examination aids in timely intervention and management of child abuse.
Unlabelled:
Violent shaking is a type of child abuse which may cause intracranial hemorrhages combined with retinal and vitreous bleeding. Fundus bleeding is similar to that in Terson syndrome. However, in the shaken baby syndrome the intraocular hemorrhages may precede both the clinical and radiologic recognition of subdural haematoma.
Case Report:
We present a 4-months-old baby with convulsions and additional extensive bleeding of the fundus. Neither the ocular findings nor the seizures could be explained by minimal lesions of external trauma. Repeated cranial computed tomography showed increasing intracerebral bleeding with consecutive brain atrophy. Fundus bleeding completely disappeared.
Conclusion:
When child abuse is suspected, ophthalmological examination is most important to detect fundus bleeding, which, in the absence of birth trauma or any other supportive evidence of external trauma or other diseases, is the leading symptom of the shaken baby syndrome.
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