Abusive Head Trauma
- Head injury inflicted by shaking
- Children under 1 year of age at risk because their neck muscles cannot stabilize head
- Associated with subdural hemorrhage, occult evidence of blunt trauma
- Principal ophthalmic manifestation: retinal hemorrhages, which result from...
- Shearing at interface of retina and vitreous
- One or more surface retinal hemorrhages, looking like red blisters
- Usually present in both eyes
- Deeper retinal hemorrhages and retinal splitting may occur in severe cases
- Blood dyscrasias, especially thrombocytopenia, but can be diagnosed with blood count
- Severe blow to eyes, but should see subconjunctival hemorrhage and hyphema
- Birth trauma, but hemorrhages disappear spontaneously within 1 month of age
- Resuscitative chest compression (sudden rise in intrathoracic pressure), but hemorrhages few and mild
- Consult ophthalmologist if you suspect abusive head trauma, especially by shaking
- Hemorrhages resolve within 4-6 weeks
- Visual recovery good unless retina has split
- Neurologic outcome depends on severity of brain injury