Swept-source OCT findings in shaken baby syndrome: case report
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CASE REPORT
Open Access
Swept-source OCT findings in shaken baby syndrome: case report Imen Ksiaa1, Mohamed Ghachem1, Habib Besbes2, Sana Khochtali1, Slaheddine Chouchane2 and Moncef Khairallah1*
Abstract Background: Our purpose was to document the swept source optical coherence tomography (SSOCT) findings in a patient with Shaken baby syndrome (SBS). Case presentation: SSOCT was obtained without sedation in a six-month-old girl with bilateral multilayered retinal hemorrhages due to SBS. It documented vitreoretinal interface abnormalities, including internal limiting membrane (ILM) detachment with retinal traction, in association with other specific changes in the inner and outer retinal layers. Six weeks later, retinal hemorrhages had substantially resolved, and there was optic disc pallor. OCT showed ILM reattachment with release of retinal traction and the development of severe diffuse retinal atrophy involving the fovea. Conclusions: SS OCT can provide useful information in SBS, revealing a wide variety of vitreoretinal interface, inner, and outer retinal changes not detected by clinical examination. It also may have a prognostic value over follow-up. Keywords: Shaken baby syndrome, Swept source optical coherence tomography, Retinal hemorrhages, Vitreoretinal interface, Case report
Background Shaken baby syndrome (SBS), also known as abusive head trauma, refers to a constellation of clinical findings including bilateral retinal hemorrhages, subdural hemorrhage, and anoxic encephalopathy [1]. Retinal hemorrhages occur in approximately 85% of cases and they typically are numerous, multilayered and widespread, involving the posterior pole and periphery [2]. Optical coherence tomography (OCT) has been found to be useful in the evaluation of retinal hemorrhages and in the detection and characterization of associated vitreoretinal abnormalities in patients with SBS. However, there are only very few reports on the use of SD-OCT, and data on the newlyintroduced swept-source (SS) OCT are lacking [2–5]. We herein report a case of SBS documented with SS OCT. * Correspondence: [email protected] 1 Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia Full list of author information is available at the end of the article
Case presentation A previously healthy six-month-old girl was brought to the emergency department for paroxysmal crying with brief episodes of loss of consciousness. On physical examination there was a bulging fontanel with associated weak axial posture. A cerebral computed tomography (CT)-scan demonstrated extensive bilateral subdural hemorrhages. The child was admitted to the Pediatric Intensive Care Unit. Ophthalmological examination revealed a poor pupillary response to bright light in both eyes. There were no external signs related to ocular trauma. Fundus examination by indirect ophthalmoscopy revealed bilateral preretinal and intraretinal hemorrhages involving the posterior pole and midperiphery. There was a bila
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