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Case 2 - Orbit: Non-accidental Trauma

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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.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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