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Eelco W. Hoving, Mehrnoush Rahmani, Leonie I. Los and Victor W. Renardel de Lavalette

subdivided into early and late failure. 2 , 19 The importance of early recognition of symptoms of increased ICP during follow-up has been recognized in this respect. This case illustrates a perioperative complication of ETV causing bilateral retinal hemorrhage, which should be considered as an example of iatrogenic Terson syndrome. The sequence of adverse events is analyzed and the nature of the ocular damage is discussed. Case Report History and Examination This 38-year-old woman was referred to our hospital with symptomatic hydrocephalus with signs of

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Joseph H. Piatt Jr

External hydrocephalus has been associated with subdural hematomas in infancy, and the hematomas have been noted to be secondary to minor trauma or have even been described as spontaneous. The author reports the case of an infant with external hydrocephalus who developed retinal as well as subdural hemorrhages after sustaining a minor head injury. Although retinal hemorrhage in infancy has been considered virtually pathognomonic of child abuse, in the setting of external hydrocephalus a more cautious interpretation may be appropriate.

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Shunsuke Amagasa, Satoko Uematsu and Satoshi Tsuji

of traumatic brain injury (SDH, epidural hematoma [EDH], subarachnoid hemorrhage [SAH], and brain edema), retinal hemorrhage, rib or long-bone fracture, and outcomes between patients whose falls were witnessed by a nonrelative and those for whom the fall was not witnessed by a nonrelative. Additionally, we compared the available head CT scans between the groups. The information about the accident site was primarily determined by the history given by the caregivers to a physician in the emergency department. In cases with inconsistencies between the history and the

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Matthieu Vinchon, Sabine Defoort-Dhellemmes, Marie Desurmont and Patrick Dhellemmes

funduscopy was omitted in the last five cases. Retinal hemorrhage was found in 47 (36.4%) of 129 cases: 42 of 56 involved child abuse and five of 73 accidental trauma. Retinal hemorrhage was absent in 14 cases of child abuse and 68 of accidental trauma. Based on these results, we could estimate the sensitivity of RH at 75% and its specificity at 93.2% for the diagnosis of child abuse; the predictive positive and negative values were 89.4 and 82.9%, respectively. The RHs were mild (Grade 1) in 10 cases. Of these cases five were caused by child abuse and five by accidental

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Richard G. Robinson

Days Post-Rupture No. of Cases Deaths No. % 0–5 15 6 6–10 26 6 29.2 11–15 16 1 16–21 13 1 6.9 22–28 8 0 29+ 6 1 Of 18 patients who had had two or more previous subarachnoid hemorrhages, eight died. Four of these eight were operated on within 21 days of the last hemorrhage, but the other four waited more than 21 days. Retinal Appearance There has been controversy as to whether subhyaloid and retinal hemorrhages constitute adverse prognostic findings with

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Kenneth W. Feldman, Naomi F. Sugar and Samuel R. Browd

abusive trauma, their clinical presentations and rates of acute and healing extracranial injuries and retinal hemorrhage should not differ from those of children with only acute SDH. We also hypothesized that if the acute SDH occurred spontaneously or as a result of nonabusive trivial trauma, then these children should have few, if any, acute extracranial injuries and/or retinal hemorrhages and few, if any, healing injuries. Likewise, we hypothesized that they should lack acute neurological symptoms, beyond those attributable to increased intracranial pressure from the

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Giovanni Broggi and Angelo Franzini

T he value of percutaneous radiofrequency trigeminal thermo-rhizotomy (TRZ) is well established in the treatment of tic douloureux 1, 6, 9–11 and in the management of cancer pain of the face. 7 Few reports have dealt specifically with TRZ performed in patients suffering from symptomatic facial pain of non-neoplastic origin. 8 This study presents the results of TRZ in 20 patients suffering from trigeminal pain secondary to multiple sclerosis, basilar impression, intracranial aneurysms, and retinal hemorrhage. The indications for this treatment are discussed

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The shaken baby syndrome

A clinical, pathological, and biomechanical study

Ann-Christine Duhaime, Thomas A. Gennarelli, Lawrence E. Thibault, Derek A. Bruce, Susan S. Margulies and Randall Wiser

T he term “whiplash shaken baby syndrome” was coined by Caffey 3 to describe a clinicopathological entity occurring in infants characterized by retinal hemorrhages, subdural and/or subarachnoid hemorrhages, and minimal or absent signs of external trauma. Because a nursemaid admitted that she had held several such children by the arms or trunk and shaken them, the mechanism of injury was presumed to be a whiplash-type motion of the head, resulting in tearing of the bridging veins. Such an injury was believed to be frequently associated with fatalities in

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Wajd N. Al-Holou, Edward A. O'Hara, Aaron A. Cohen-Gadol and Cormac O. Maher

until the 1950s did the medical community begin to widely recognize child abuse, and not until the 1962 publication of “The Battered-Child Syndrome” by Kempe et al. 40 did the topic become actively discussed and accepted in hospitals nationwide. 70 Nonaccidental injury can present in many ways with varying physical signs. One form of child abuse known as shaken baby syndrome was first described in the 1970s. This syndrome is thought to be caused by shaking an infant to the extent that it causes SDHs, retinal hemorrhages, and encephalopathy. It can be accompanied by

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Patrick Graupman and Ken R. Winston

. When it was available, the mean arterial pH at admission (generally obtained after resuscitation and intubation) was 7.28 (25 patients). Two of the children (19 and 44 months of age) who presented with apnea had a fractured skull. At the time of admission, every child had a decreased level of consciousness, and 81% had retinal hemorrhages ( Table 6 ). Forty-seven percent of patients were coagulopathic, which is a slightly smaller proportion than in a previous report. 16 Approximately two thirds of the children had coagulation studies available for review. The mean