Swept-source OCT findings in shaken baby syndrome: case repo
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Shaken baby syndrome (SBS), also known as abusive head trauma, refers to a constellation of clinical findings including bilateral retinal hemorrhages, subdural hemorrhage, and anoxic encephalopathy. Retinal hemorrhages occur in approximately 85% of cases and they typically are numerous, multilayered, and widespread, involving the posterior pole and periphery.

A previously healthy six-month-old girl was brought to the emergency department for paroxysmal crying with brief episodes of loss of consciousness. On physical examination, there was a bulging fontanel with associated weak axial posture. A cerebral computed tomography (CT)-scan demonstrated extensive bilateral subdural hemorrhages. The child was admitted to the Pediatric Intensive Care Unit. Ophthalmological examination revealed a poor pupillary response to bright light in both eyes. There were no external signs related to ocular trauma. Fundus examination by indirect ophthalmoscopy revealed bilateral preretinal and intraretinal hemorrhages involving the posterior pole and midperiphery. There was a bilateral boat-shaped premacular hemorrhage. This hemorrhage was larger and associated with a prominent surrounding ring-shaped white retinal fold in the right eye. A diagnosis of SBS was made based on the patient’s neurological status, and fundoscopic and CT-scan findings. The baby-sitter looking after the child confessed to abusing her. The neurological condition was managed with intravenous mannitol, along with close monitoring.

Three days after hospitalization, the patient underwent swept source OCT imaging with the DRI OCT Triton plus (Topcon, Tokyo, Japan). Multiple SS-OCT scans could be obtained without sedation, the infant being held and her eyelids kept open by an assistant. OCT confirmed multilayered retinal hemorrhages in both eyes. It showed a dome-shaped detachment of the internal limiting membrane (ILM) overlying the macular hematoma bilaterally, with associated perifoveal retinal traction corresponding to the retinal fold seen clinically in the right eye. Other SS OCT findings included hyperreflective vitreous dots representing individual red blood cells, wave-shaped retinal layers deformation, diffuse inner retinal hyperreflectivity, ellipsoid zone disruption, intraretinal hyperreflective dots, and serous retinal detachment. The foveal pit was not identifiable. The retinal pigment epithelium and choroid appeared to be normal in both eyes.

Sequential follow-up examinations showed a gradual resolution of the neurological symptoms and improvement of pupillary response to light. Six weeks after initial examination, retinal and preretinal hemorrhages had substantially resolved, and there were bilateral areas of subretinal fibrosis and optic disc pallor, mainly in the right eye.

Source: https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01666-9