Postmortem orbital findings in shaken baby syndrome.
OBJECTIVE
To compare postmortem orbital findings in pediatric accidental head injury to Shaken Baby Syndrome (SBS).


METHODS
Retrospective study.


METHODS



METHODS
Institutional.


METHODS
Thirty-six patients underwent postmortem modified exenteration with sectioning of the orbital contents; 18 victims of SBS and 18 cases of fatal accidental head trauma.


METHODS
In all cases of children who died from accidental head trauma, the orbital tissues were separated to expose the optic nerve sheath. Patients with gross evidence of hemorrhage within the sheath were included. All cases of SBS were included. After accidental head injury, exenteration was performed only if optic nerve sheath hemorrhage was suspected on gross examination. All children younger than 18 years old with head injury as primary cause of death were included. SBS is defined as having at least two of the following: (1) typical abnormal findings on neuroimaging, (2) typical skeletal injury, (3) retinal hemorrhages, (4) history of abusive shaking with or without blunt head trauma, or (5) an inadequate history to explain the observed injuries.


METHODS
Presence or absence of orbital hemorrhage.


RESULTS
Orbital tissue injury is more common in SBS than accidental head trauma without orbital fracture. In addition, optic nerve sheath and optic nerve intradural hemorrhage are also significantly more common in SBS (P < .0001).


CONCLUSIONS
Our study reports new evidence of injury to orbital tissues in SBS and supports the concept that these finding are due to unique acceleration-deceleration forces of this type of abusive head injury.
Wygnanski-Jaffe
Tamara
T
Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Levin
Alex V
AV
Shafiq
Ayad
A
Smith
Charles
C
Enzenauer
Robert W
RW
Elder
James E
JE
Morin
J Donald
JD
Stephens
Derek
D
Atenafu
Eshetu
E
D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D005260:Female; D049429:Forensic Pathology / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D009915:Orbit / Q000293:injuries*; D017233:Orbit Evisceration / Q000379:methods; D012166:Retinal Hemorrhage / Q000175:diagnosis*; D019315:Retrobulbar Hemorrhage / Q000175:diagnosis*; D012189:Retrospective Studies; D038642:Shaken Baby Syndrome / Q000175:diagnosis*