Shaken Baby Syndrome Defense

False Assumption #5:
Retinal hemorrhages only come from "Shaken Baby Syndrome" or nonaccidental trauma.

Truth:
Retinal hemorrhages can be found in a myriad of different scenarios (child birth, CPR, coagulation disorders or any scenario that gives you a sudden increase in intracranial pressure). Retinal hemorrhages cannot be pathologically interpreted or dated with any accuracy. Retinal hemorrhages are generally caused by a sudden increase in intracranial pressure.

Prosecutors and proponents of Shaken Baby Syndrome assert that retinal hemorrhages are pathoneumonic for (i.e. diagnostic of) Shaken Baby Syndrome. In fact, retinal hemorrhages are found in a myriad of different conditions, most of which result in a sudden increase in intracranial pressure. A human head is a closed space, with limited spare room for things like bleeding and swelling. Therefore, when the brain has reached its cranial capacity, but is still increasing in mass, it becomes compressed and pushes down toward the only escape route- the foramen magnum. The mechanisms behind the respiratory arrest or death in "SBS" cases are also the result of increased intracranial pressure. Retinal hemorrhages are found in 30-40% of all vaginal births (1). Other known causes of retinal hemorrhages include: CPR (2); coagulation disorders (3); accidental trauma (4); strangulation (5); scurvy, (6); and other conditions that cause central retinal vein occlusion. (7, 8). Retinal hemorrhages are commonly found with subarachnoid hemorrhages (9) and are indistinguishable from those found in patients with subdural hematomas (10). Retinal hemorrhages have also been observed after vaccination with Hepatitis B Vaccine (11), and in persons with or autoimmune disorders such as Goodpaster's Syndrome (12).

Citations

1. Kaur B, & Taylor D. (1990) Current Topic: Retinal Hemorrhages. Arch. Dis. Child 65:1369 - 1372.

2. Goetting MG, Sowa B (1990). Retinal hemorrhage after cardiopulmonary resuscitation in children: an etiologic reevaluation. Pediatrics 85:585-588.

3. Nelson, L. Disorders of the Eye. In: Textbooks of Pediatrics. Behrman, R., Kliegman, R., Arvin, A. Fifteenth Edition. W.B. Saunders Company (Philadelphia). 1996. pgs. 1790-1797.

4. Elner SG, Elner VM, Arnall M, Albert DM.(1990) Ocular and associated systematic findings in suspected child abuse. A necropsy study. Arch Ophthal 108: 1094-1101.

5. Spitz and Fisher: Medicological Investigation of Death. Supra

6. Hess, A. Scurry Past and Present. J.P. Lippincott Company. Philadelphia and London. 1920.

7. Gutman, F. (1983). Evaluation of a Patient with Central Vein Occlusion. American Academy of Ophthalmology. 90(5) 481-483.

8. Iijima H, Gohdo T, Imai M, & Tsukahra S. (1998) Thrombin-Anti-thrombin III Complex in Acute Retinal Vein Occlusion. American Journal of Ophthalmology 126(5): 677-682.

9. Biousse, V., Mendicino, M., Simon, D. and Newman, N. (1998). The Ophthalmology of Intracranial Vascular Abnormalities. American Journal of Ophthalmology 125(4):527-544.

10. Budenz DL, Farber MG, Mirchandani HG, Park H, Rorke LB (1994). Ocular and optic nerve hemorrhages in abused infants with intracranial injuries. Ophthalmol 101:559-565.

11. Devin F, Roques G, Disdier P, Rodor F, Weiller P.J, (1996). Occlusion of central retinal vein after hepatitis B vaccination. The Lancet Vol. 147: 1626.

12. Boucher,M.C. et. al. (1998) The Photo Gallery of Clinical Opthamology: Bilatera Serous Retinal detachments associated with Goodpasters's syndrome. Canadian Journal of Opthamology 33:46-47.

13. Matson, Neurosurgery of Infancy and Childhood.

Defense Strategy for Allegations of Shaken Baby Syndrome