View larger version (40K):
[in this window]
[in a new window]
|
A five-month-old girl was admitted to the hospital because of uncontrollable seizures. Her father had shaken her vigorously, allegedly in an attempt to rescue her from a choking spell. A computed tomographic scan of her head revealed a right frontal subdural hematoma, left frontal and temporal subdural hematomas, an interhemispheric hemorrhage, a subarachnoid hemorrhage, and a right lambdoid diastasis. On ophthalmologic examination, the child appeared to fixate on but not to follow objects. The pupils were 5 mm in diameter and slowly reactive. There was no afferent pupillary defect. The results of extraocular motility and slit-lamp examinations were normal. The intraocular pressure was 12 mm Hg bilaterally. After dilation of the pupils, an ophthalmoscopic examination revealed normal disks and multiple intraretinal and preretinal hemorrhages (asterisk) in the posterior pole of both eyes. The clinical feature believed to be pathognomonic for the shaken-baby syndrome, the circumpapillary retinal ridge, was present in the left eye (arrows).
The child was placed in foster care; at the most recent follow-up visit (five months later), she was able to fixate on and follow objects visually and to pick them up with both hands. Her retinal hemorrhages had resolved, leaving subtle residual pigment abnormalities bilaterally.
|
Previous
