Retinal hemorrhage and pediatric brain injury: etiology and review of the literature

Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury

“…More comprehensive case series were soon to follow [53, 86,87]. Since then, the number of papers has steadily risen over the years, with the emphasis and focus of the literature becoming continuously diverse, stressing the need for this topical review for the forensic pathologist [1,5,45,65,66,70,72,84].…”

“…It is generally held that retinal hemorrhage and optic nerve sheath hemorrhages form an essential part of the NAHI/ SBS complex, but most researchers agree that both are neither necessary nor sufficient for diagnosis [5]. For victims of child abuse in general, frequencies of RH have been reported between 40% and 61% [34, 100,101].…”

“…There are substantial numbers of cases reporting RH in infants due to apparently innocent causes, or in the context of a variety of medical disease such as spinal arteriovenous malformation [19], fibromuscular dysplasia [20], osteogenesis imperfecta type I [36], blood dyscrasias [76], and Coats' disease [5]. Although some of these may be associated with minor accidental trauma, stigmata of the underlying disorder allow its recognition usually rather quickly, absolving the physician from the need for further inquiry for suspected child abuse [113].…”

Abusive head trauma: Report of 3 cases

“…However, they are neither necessary nor sufficient for diagnosis. [13] RH are observed in 50 to 100% of AHT cases depending on the severity of cases included in case series. [5,14] RH in AHT are typically bilateral; however, unilateral hemorrhages occur in nearly 15% of cases.…”

A Witnessed Short Fall Mimicking Presumed Shaken Baby Syndrome (Inflicted Childhood Neurotrauma)

“…With regards to the ocular findings in inflicted neurotrauma, the medical literature is quite expansive [8][9][10] but does reflect clinical outliers [11,12] . Given this, the author's conclusion: 'Unless and until the ocular findings of presumed shaken…”