title: Retinal hemorrhages in an 8-year-old child: an uncommon presentation of abusive injury.
abstract: OBJECTIVE
  Retinal hemorrhages in pediatric patients have been best described as a component of shaken baby syndrome (SBS), which has been described almost exclusively in the infant/toddler population. We describe the occurrence of retinal hemorrhages in the setting of abusive injury in an older child.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  An 8-year-old boy was transferred to our institution with coma and respiratory arrest. Evaluation demonstrated intracranial hemorrhage, cerebral edema, and severe bilateral retinal hemorrhages. The patient subsequently died of intractable intracranial hypertension. Police investigation confirmed that the injuries were caused by severe abusive injury, including shaking.
  
  
  CONCLUSIONS
  This case emphasizes that the diagnosis of SBS is not limited to babies and that the possibility of abusive shaking injury should also be considered in older children presenting with intracranial pathology and retinal hemorrhages.
authors.affiliation: *Department of Child Health, University of Missouri-Columbia, Columbia, MO; †Department of Pediatrics, University of Utah, Salt Lake City, UT; ‡Division of Medical Genetics, University of Missouri-Columbia, Columbia, MO; §Department of Ophthalmology, University of Missouri-Columbia, Columbia, MO; ∥Division of Pediatric Critical Care/Pediatric Anesthesiology, University of Missouri-Columbia, Columbia, MO.
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Mierisch
authors.forename: Lori D
authors.initials: LD
authors.lastname: Frasier
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Braddock
authors.forename: Joseph
authors.initials: J
authors.lastname: Giangiacomo
authors.forename: John W
authors.initials: JW
authors.lastname: Berkenbosch
mesh_terms: D001929:Brain Edema / Q000209:etiology; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D017809:Fatal Outcome; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000209:etiology; D008297:Male; D012166:Retinal Hemorrhage / Q000209:etiology*; D038642:Shaken Baby Syndrome / Q000150:complications* / Q000175:diagnosis