Case 2 - Orbit: Non-accidental Trauma
HIDEInteractive Transcript
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I want to make a quick point about non-accidental
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trauma or shaken baby syndrome or child abuse,
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and that is that retinal hemorrhages are one of the
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most common manifestations of
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injury in non-accidental trauma.
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We're used to looking for subdural hematomas in
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patients who have non-accidental trauma.
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And we want to look at subdural
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hematomas of different ages.
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So this one would be our chronic one that is
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low density. This one is a hyperacute one,
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which is of the higher density. Hemorrhages
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along the interhemispheric
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fissure is also very characteristic of
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non-accidental trauma. However,
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it's been reported that 70% to 90% of children who have
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suffered through shaken baby syndrome also have little
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areas of retinal hemorrhage that can be
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seen on ocular imaging. So this maybe,
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in some cases,
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the only manifestation of the childhood injury.
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But it also may help settle the case as to whether or not
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this could be secondary to intentional
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trauma to the child.
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Here is what the hemorrhages look like on the
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ophthalmologic funduscopic examination.
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It's these little areas of blood products which
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you see in multiple locations,
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which represents little shearing
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injuries of the retina.
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And funduscopic evaluation is definitely
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more sensitive than our CT scan,
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but occasionally we will see those areas of retinal
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hemorrhage and/or retinal detachment that
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are associated with non-accidental trauma.
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So after you've looked at the brain,
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after you've looked at the musculoskeletal system and
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look for the various types of fractures,
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do come back to the brain,
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take out those thin section orbital images
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and look for those little areas
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of potential retinal hemorrhage
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that might be additional evidence
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of non accidental trauma.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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