Whiplash shaking syndrome: retinal hemorrhages and computerized axial tomography of the brain |
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| Authors: | J E Carter A Q McCormick |
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| Institution: | Assistant Professor, Director, Child Protection Service, Department of Pediatrics, University of British Columbia Faculty of Medicine, B.C.''s Children''s Hospital, 4480 Oak Street, Vancouver, B.C. V6H 3V4 Canada;Associate Clinical Professor, Department of Ophthalmology and Clinical Associate, Department of Pediatrics, University of British Columbia, Faculty of Medicine 4480 Oak Street, Vancouver, B.C. V6H 3V4 Canada |
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| Abstract: | Three cases of whiplash shaking injury of infants are presented. All children presented with seizures and had minimal signs of external injury. Examination of the retina revealed extensive retinal hemorrhages. These were missed on initial examination and were only discovered after pupillary dilatation. The presence of these palecentered retinal hemorrhages suggested the diagnosis of child abuse and skeletal surveys and thorough social histories confirmed the diagnosis. Despite extensive retinal hemorrhages, computerized axial tomography (C.T.) scan showed minimal inter-hemispheric bleeding. In contrast to the "Battered Child Syndrome," all the findings in whiplash shaking syndrome of infants are subtle and demand an awareness, an index of suspicion and a thorough examination which may include extensive retinal examination following dilatation of the pupils. This latter examination is frequently not performed by family physicians and residents so that the syndrome may be missed. A fourth case is also discussed where shaking is admitted on initial presentation but said to be done for resuscitation. This poses an immense diagnostic dilemma to the pediatrician since in this case the child presented later with all the signs of physical abuse. |
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| Keywords: | Address reprint requests to Dr J E Carter B C 's Children's Hospital 4480 Oak St Vancouver BC Canada V6H 3V4 |
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