Diagnosis of Shaken Baby Syndrome
Shaken Baby Syndrome Diagnosis: Book Excerpts
Diagnosis of Shaken Baby Syndrome: medical news summaries:
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Diagnostic Tests for Shaken Baby Syndrome: Online Medical Books
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Retinal Hemorrhage:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
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It is critical to realize that hemorrhages do not progress but represent altered structure, and as such may affect acuity
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Nonaccidental trauma must be the first etiology considered
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Pigmented lesions of the retina including choroidal nevi, congenital hypertrophy of the retinal pigment epithelium, retinal pigment epithelial hyperplasia
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Diabetic retinopathy is characterized by dot/blot, flame, preretinal, vitreous hemorrhages
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Hypertensive retinopathy is typically accompanied by signs of hypoxia, e.g., cotton wool spots and optic disc swelling
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May be associated with any systemic vascular disease or collagen vascular disease (e.g., systemic lupus erythematosus)
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Vein occlusion
–Occlusion of a central vein may involve the entire retina, occlusion of one branch vein involves a section of the retina
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Peripheral retinal hemorrhaging may be associated with vascular insufficiency due to carotid stenosis
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May be associated with optic disc swelling
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Traumatic truncal injury may create intraretinal hemorrhages called Purtscher lesions
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Intracranial hemorrhage may dissect forward to surround optic nerve (Terson phenomenon)
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Blood dyscrasias, anemias, leukemias, sickle cell, ocular sarcoidosis, Behçet disease, Eales disease may cause retinopathy
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If sudden loss of vision is associated, wet macular degeneration, macular hemorrhage of histoplasmosis, preretinal hemorrhage, or vitreous hemorrhage may be the etiology
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Retinal vascular tumors, which may have an associated neurologic aneurysm
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HIV retinopathy presents with hemorrhage as first sign but may progress to involve and destroy vision
Workup and Diagnosis
- History
–Evaluate status of known systemic diseases; e.g., hypertension, diabetes
–Investigate for undiagnosed systemic disease: Hypertension, diabetes, carotid occlusion, cardiac anomalies, blood disorders, HIV
- Physical exam
–Visual acuity: Acuity is compromised if the hemorrhage lies within the foveal area
–Pupillary evaluation: Look for Marcus Gunn pupil
–Extraocular muscle evaluation for diplopia (may be
associated with diabetes)
–Confrontation visual fields are indicated in all cases
–Perform a dilated fundus evaluation - Labs
–CBC, differential, lipid profile, ANA, sickle cell, ACE, serum calcium
- Studies
–Ultrasonography, fluorescein angiography, ocular CT may be performed in conjunction with an ophthalmology consultation
–If secondary to a retinal vascular tumor, orbital and brain imaging with and without contrast is indicated with a neurologic consultation
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Retinal Phenomena:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Hypertension
❑ Diabetic retinopathy
❑ Glaucoma
❑ Cholesterol emboli
❑ Papilledema
❑ Pigmented crescent
❑ Macular degeneration
❑ Retinal detachment
❑ Acute optic neuritis
❑ Optic atrophy
❑ Retinal hemorrhage
❑ Chorioretinal exudates
❑ Lipemia retinalis
❑ Central retinal artery occlusion
❑ Central retinal vein occlusion
❑ Angioid streaks
❑ Hyperviscosity
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
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