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December 2006

Retinal Hemorrhages of Crush Head Injury: Learning From Outliers

Arch Ophthalmol. 2006;124(12):1773-1774. doi:10.1001/archopht.124.12.1773

It has been 35 years since Guthkelch and then Caffey first described what has come to be called shaken baby syndrome (SBS).1-3 In the intervening period, copious amounts of research have allowed us to accumulate a thorough knowledge of the clinical manifestations and expanded understanding of the pathophysiologic nature of this often lethal form of child abuse. It has been estimated that approximately 24 to 32 per 100 000 children younger than 2 years old are victims in the United States and Canada.4,5 A hemorrhagic retinopathy is well recognized as one of the cardinal manifestations of SBS along with intracranial bleeding, cerebral edema, and parenchymal injury and characteristic skeletal injuries.6 Blunt impact of the head may or may not be present. Approximately two thirds of victims exhibit retinal hemorrhages that are too numerous to count, intraretinal, preretinal, subretinal, and distributed throughout the retina to the ora serrata.7,8 Traumatic retinoschisis, first described in 1986,9 with or without circumlinear perimacular folds occurs in up to one third of patients7 and has been recognized as a particularly diagnostic sign.6

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