title: Severe Retinal Hemorrhages with Retinoschisis in Infants are Not Pathognomonic for Abusive Head Trauma.
abstract: The combination of subdural hemorrhage (SDH), retinal hemorrhage (RH), and encephalopathy, or the presence of severe retinal hemorrhages alone in infants, is often attributed to and has been stated to be pathognomonic for abusive head trauma (AHT) or shaken baby syndrome. These beliefs have been challenged, because the same constellation of findings has been identified in accidental head injuries and natural diseases, and most if not all of the studies that support the concept of diagnostic specificity have serious flaws in their methodology. Presented here are two cases of severe retinal hemorrhages with retinoschisis associated with subdural hemorrhage in a natural disease and with severe cerebral edema in an accidental head injury. These cases challenge the dogma that severe retinal hemorrhages with retinoschisis are pathognomonic for AHT.
authors.affiliation: Medical Examiner Department, Miami Dade County, Number One on Bob Hope Road, Miami, FL, 33136.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Shuman
authors.affiliation: Medical Examiner Department, Miami Dade County, Number One on Bob Hope Road, Miami, FL, 33136.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Hutchins
mesh_terms: D000058:Accidental Falls; D001929:Brain Edema / Q000473:pathology; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000473:pathology; D002649:Child Abuse / Q000175:diagnosis; D003937:Diagnosis, Differential; D016489:Head Injuries, Closed / Q000150:complications*; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D012166:Retinal Hemorrhage / Q000209:etiology* / Q000473:pathology; D041441:Retinoschisis / Q000209:etiology* / Q000473:pathology; D038642:Shaken Baby Syndrome / Q000175:diagnosis; D013116:Spinal Cord / Q000002:abnormalities
keywords: abusive head trauma; forensic science; infant head injury; retinal hemorrhage; retinoschisis; shaken baby syndrome; subdural hemorrhage; vascular malformation