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Kivlin et al1 note “dome-shaped [retinal] hemorrhages” in 60% of their cases and attribute these to mechanical forces exerted on the retina by the vitreous during violent acceleration/deceleration and rotational ocular movement from severe motor vehicle accidents.
These “dome-shaped hemorrhages” are in fact bubbles. Bubbles are produced, not from vitreous traction, which may produce ridges (or “folds”), but by hydraulic forces—they are “blown.”
All the ocular findings attributed to shaken baby syndrome have been produced without mechanical (acceleration/deceleration or rotational) forces. Thus, mechanical forces are not “necessary.” Also, mechanical forces are not “sufficient” to produce many of the findings, such as the “hemorrhages at all levels” and vitreous hemorrhage noted in these patients, because mechanical forces cannot draw blood into the multiple retinal layers without blood vessels or into the avascular vitreous. Hydraulic forces are necessary to move blood into these areas. Hydraulic forces are indeed sufficient to produce all the ocular findings attributed to shaken baby syndrome. Schisis cavities in the macular area (labeled premacular hemorrhage in the literature) have been reported in Terson syndrome,2 Valsalva retinopathy, and vein occlusion,3 all hydraulic phenomena. Retinal and optic nerve sheath hemorrhages have been produced experimentally by increasing intracranial pressure.4
The ocular findings in these 10 cases are likely to be the result of changes in intracranial pressure and intravascular pressure (blood pressure, thoracic-abdominal pressure) rather than the result of mechanical forces from the motor vehicle crash itself.
Correspondence: Dr Gardner, 318 Oklahoma Rd, Manitou Springs, CO 80829 (horacebgardner@yahoo.com).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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