Search

Purpose: Compare follow-up optical coherence tomography with visual function in children with abusive head trauma (shaken baby syndrome). Methods: Retrospective follow-up studies of three children who were victims of abusive head trauma within the first year of life. Results: Optical coherence tomography showed disrupted retinal layering, thick detached internal limiting membrane, focal posterior vitreous separation, and multilayered tractional retinoschisis. Significant vision loss occurred in three of four eyes with a history of traumatic retinoschisis. Normal visual acuity and low-normal visual-evoked potentials were measured in a child with foveal distortion, reduced global nerve fiber layer thickness, detached internal limiting membrane, and history of vitreous hemorrhage. Conclusion: Significant abnormalities of retinal anatomy can be detected on optical coherence tomography years after abusive head trauma. Optical coherence tomographies and assessment of visual pathways help to elucidate causes of visual dysfunction in children with abusive head trauma. [ABSTRACT FROM AUTHOR]

A leading cause of death and disability in infancy is abusive head trauma (AHT) and there are common clinical signs that help to establish this diagnosis. Children diagnosed with AHT can have many ophthalmologic findings, including retinal hemorrhages, retinoschisis, subconjunctival hemorrhages, corneal injury, and globe rupture. If any such injuries are suspected, an ophthalmologic consultation, with indirect ophthalmoscopy, should be completed. In addition to a complete physical exam, a thorough history imaging, and lab work, should be obtained to investigate the etiology of ophthalmic pathology including accidental and systemic causes. In general, studies show that retinal hemorrhages that are multilayered, too numerous to count, and located from the posterior pole to the ora serrata are highly suspicious for abusive head trauma. [ABSTRACT FROM AUTHOR]

Background: To determine the predictive value of retinal microvascular abnormalities for cerebrovascular ischemic diseases (CVDs), we aimed to investigate the quantitative association between retinal microvascular changes and CVD subcategories: white matter hyperintensities (WMHIs), lacunar infarcts (LIs), and cerebral infarctions (CIs).Methods: Using Meta-analyses Of Observational Studies in Epidemiology guidelines, we searched 6 databases through September 2016 for studies evaluating the linkage between retinal microvascular abnormalities and WMHI, and LI and CI. Studies were included if they reported odds ratios (ORs) and 95% confidence intervals or raw patient level data (that were computed into ORs). Unadjusted and vascular risk-factor adjusted ORs were pooled into meta-analysis using DerSimonian Laird random effects model. Study quality and dissemination biases were assessed and integrated.Results: From 24,444 search-identified records, 28 prospective studies encompassing 56,379 patients were eligible for the meta-analysis. After vascular risk-factor adjustment, focal arteriolar narrowing was associated with WMHI (OR, 1.24 [1.01-1.79]), LI (OR, 1.77 [1.14-2.74]), and CI (OR, 1.75 [1.14-2.69]). Venular dilation was associated with LI (OR, 1.46 [1.10-1.93]), and retinal hemorrhages with WMHI (OR, 2.23 [1.34-3.70]). Any retinopathy exhibited significant association with CI (OR, 1.96 [1.65-2.50]). Heterogeneity was significant (I2>50%) for all syntheses except retinal hemorrhages and WMHI, and retinopathy and CI (I2=0 ⋅ 0%). Associations remained significant after adjustments for quality and publication bias.Conclusions: We found the most significant association between retinal hemorrhages and WMHI. Focal arteriolar narrowing and retinopathy predicted CVD subtypes after risk-factor adjustment, suggesting that features different than traditional vascular risk factors, are involved in CVD pathophysiology. [ABSTRACT FROM AUTHOR]

In the recently published article in this journal, "Mimics of Child Abuse: Can Choking Explain Abusive Head Trauma?",(1) the author chose to revisit a discussion prompted by a case report from 5 years ago which was inappropriate in his opinion. He went further to suggest that bringing an unvalidated mechanism of injury into the legal setting "obstructs justice", is a "further victimization of the child", and is a "travesty of justice".(1) Given the "Shaken Baby Syndrome: Rotational Cranial Injuries" has always been only an unvalidated hypothesis lacking experimental confirmation, the exploring of alternative injury mechanisms should be entirely appropriate. In 2010, the post publication discussion ended with a challenge to the American Academy of Pediatrics Committee on Child Abuse and Neglect (AAP COCAN) to either support the pure shaking mechanism with quality EBMS or eliminate any positive support for it from any official policy statement until the exact nature of each injury that pure abusive shaking has the potential to cause is clearly defined and supported with quality experimental research.(4) Since this is an area of acknowledged controversy by the AAP, it is appropriate to examine the evidence based experimental literature that has emerged over the last five years that is relevant to the abusive shaking hypothesis and the hypothesis of any primary brain-lethal hypoxic event leading to the findings of retinal hemorrhages, extra-axial bleeding, and brain injury when an infant presents to medical attention after an Acute/Apparent Life Threatening Event. In that light, this review was undertaken. [ABSTRACT FROM AUTHOR]

Abusive head trauma causes significant morbidity and mortality in infants and young children. The diagnosis of abusive head trauma can be difficult. Emergency medical providers frequently have initial contact with patients presenting with abusive head injuries. It is important for emergency medical providers to consider child abuse in the differential diagnosis of head trauma and to know how to perform a comprehensive evaluation when it is suspected. The pearls and pitfalls of diagnosing abusive head trauma are discussed in this article. Information on patient outcomes and the legal responsibilities of the medical provider are also described. [Copyright &y& Elsevier]

West Nile virus (WNV), a mosquito-borne RNA virus for which there is no treatment, began emerging as a threat to health in the United States in 1999. Since then, its frequency and apparent clinical severity have increased. Patients with severe disease may experience ocular complications that include pain, vitreous inflammation, nonrelapsing chorioretinitis, retinal vasculitis, chorioretinal scarring, optic neuritis, and retinal hemorrhages. Age appears to be a risk factor for the development of ocular symptoms. Most patients with ocular involvement report floaters or decreased vision. Many ocular inflammatory conditions with an associated underlying systemic cause often present with chorioretinitis. However, the characteristic distribution and linear array or scattered pattern of the chorioretinal lesions seen in WNV is distinctive. The foregoing notwithstanding, other multifocal choroidopathies must be considered including syphilis, ocular histoplasmosis, multifocal choroiditis, tuberculosis, and sarcoid. Although topical steroids were reported to resolve WNV-induced uveitis and its associated keratic precipitates, most cases resolved irrespective of treatment, and relapses were uncommon. It is important for the eye care professional to be alert to the possible presence of WNV, particularly in older patients who present with ocular symptoms during mosquito season. Thus, a thorough ocular evaluation should include a dilated fundus examination and, when indicated, fluorescein angiography should be performed in patients suspected of being infected with WNV. [Copyright &y& Elsevier]

Copyright of EMC-Veterinaire is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abusive head trauma is a specific type of child maltreatment associated with high morbidity and mortality rates that can be challenging to diagnose as there is often no history or a fabricated one. Including the diagnosis in a differential requires a high level of suspicion from frontline providers especially when the clinical presentation is subtle as signs and symptoms can mimic other common conditions in pediatrics. This may result in a delayed or missed diagnosis. A thorough and comprehensive history and physical exam and complete documentation are essential for timely diagnosis. Consultation with a child abuse pediatrician is recommended if available. This article reviews current knowledge of the epidemiology, presenting signs and symptoms, clinical findings, and differential diagnosis of abusive head trauma with a focus on relevant information for the emergency department care provider. [ABSTRACT FROM AUTHOR]