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Case Report/Case Series | Journal Club

Shaken Adult Syndrome:  Report of 2 Cases

Amir A. Azari, MD1; Mozhgan R. Kanavi, MD1,2; Noah B. Saipe, MD1; Heather D. Potter, MD1; Daniel M. Albert, MD1,4; Michael A. Stier, MD3
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
2Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison
4McPherson Eye Research Institute, University of Wisconsin, Madison
JAMA Ophthalmol. 2013;131(11):1468-1470. doi:10.1001/jamaophthalmol.2013.5073.
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Importance  To establish that the intracranial and ophthalmologic findings present in victims of abusive head trauma can also be seen in shaken adults.

Observations  We report 2 cases of shaken adults with intracranial and ophthalmologic findings that resulted from repetitive acceleration-deceleration injury. These findings included intracranial hemorrhages, hemorrhages involving the optic nerve sheath, intraretinal and subretinal hemorrhages, and macular folds.

Conclusions and Relevance  The intracranial and ophthalmologic findings that are characteristic of abusive head trauma—subdural hemorrhages, optic nerve sheath hemorrhages, and retinal hemorrhages—are generally thought to be limited to young children and infants. Adults may also be victims of shaking abuse, and an ophthalmic examination may be beneficial when shaking is suspected.

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Figure.
Histological Examination With Hematoxylin and Eosin Stain From Case 2

Histological studies reveal extensive optic nerve sheath hemorrhage. Intraretinal hemorrhages (A), subretinal space hemorrhage (B), and hemorrhage at the orra serrata and vitreous hemorrhage (C) were also present. D, Macular folds are shown. E, Identical findings of variable degrees are observed in case 1. Scale bar = 200 μm in panel A, 800 μm in B, 400 μm in C, 200 μm in D, and 600 μm in E.

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