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Controversy # 5
Retinal Hemorrhages Only Occur in Shaken Baby Syndrome
Prosecutors and proponents of shaken baby syndrome assert that retinal
hemorrhages are pathoneumonic for (i.e. diagnostic of) shaken baby syndrome.
In fact, retinal hemorrhages are found in a myriad of different conditions
most of which result in a sudden increase in intracranial pressure. A
human head is a closed space, with limited spare room for things like
bleeding and swelling. Therefore, when the brain has reached its cranial
capacity but is still increasing in mass, it becomes compressed as it
is pushed down toward the only escape route; the foramen magnum. The mechanisms
behind the respiratory arrest or death in "sbs" cases are also
the result of increased intracranial pressure. Retinal Hemorrhages are
found in 30-40% of all vaginal births (1) and with; in CPR (2);
coagulation disorders (3); accidental trauma (4); strangulation, (5);
scurvy, (6); and conditions that cause central retinal vein occlusion.
(7, 8). Retinal hemorrhages are commonly found with subarachnoid hemorrhages
(9) and are indistinguishable from those found in patients with subdural
hematomas (10). Retinal hemorrhages have also been observed after vaccination
with Hepatitis B Vaccine (11); and in persons with or autoimmune disorders
such as Goodpaster's Syndrome (12).
Citations
1. Kaur B, & Taylor D. (1990) Current Topic: Retinal Hemorrhages. Arch. Dis. Child 65:1369 - 1372.
2. Goetting MG, Sowa B (1990). Retinal hemorrhage after cardiopulmonary resuscitation in children: an etiologic reevaluation. Pediatrics 85:585-588.
3. Nelson, L. Disorders of the Eye. In: Textbooks of Pediatrics. Behrman, R., Kliegman, R., Arvin, A. Fifteenth Edition. W.B. Saunders Company (Philadelphia). 1996. pgs. 1790-1797.
4. Elner SG, Elner VM, Arnall M, Albert DM.(1990) Ocular and associated systematic findings in suspected child abuse. A necropsy study. Arch Ophthal 108: 1094-1101.
5. Spitz and Fisher: Medicological Investigation of Death. Supra
6. Hess, A. Scurry Past and Present. J.P. Lippincott Company. Philadelphia and London. 1920.
7. Gutman, F. (1983). Evaluation of a Patient with Central Vein Occlusion. American Academy of Ophthalmology. 90(5) 481-483.
8. Iijima H, Gohdo T, Imai M, & Tsukahra S. (1998) Thrombin-Anti-thrombin III Complex in Acute Retinal Vein Occlusion. American Journal of Ophthalmology 126(5): 677-682.
9. Biousse, V., Mendicino, M., Simon, D. and Newman, N. (1998). The Ophthalmology of Intracranial Vascular Abnormalities. American Journal of Ophthalmology 125(4):527-544.
10. Budenz DL, Farber MG, Mirchandani HG, Park H, Rorke LB (1994). Ocular and optic nerve hemorrhages in abused infants with intracranial injuries. Ophthalmol 101:559-565.
11. Devin F, Roques G, Disdier P, Rodor F, Weiller P.J, (1996). Occlusion of central retinal vein after hepatitis B vaccination. The Lancet Vol. 147: 1626.
12. Boucher,M.C. et. al. (1998) The Photo Gallery of Clinical Opthamology: Bilatera Serous Retinal detachments associated with Goodpasters's syndrome. Canadian Journal of Opthamology 33:46-47.
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