Yes, I saw a summary of that paper in the new service Grand Rounds produced by AAP. Michael Ryan >>> "Dogwood Ridge" <> 24/February/1999 02:45pm >>> The British Journal of Ophthalmology did a nice study showing that convulsions don't cause retinal hemorrhages. (no, I don't get this journal, but I read a good abstract with commentary in the AAP Grand Rounds publication). Regards- Kim Burlingham, MD -----Original Message----- From: Michael Ryan <> To: <>; <> Date: Monday, February 22, 1999 12:17 AM Subject: Case: Shaken Baby Syndrome? -Reply >The story is very similar to the case that I am >currently dealing with in Sydney. The only difference >is that in my case there was no fall. > >Retinal haemorrhages require a great deal of force >for their production. Duhaime reported on 10 cases >of infants with head injury who had retinal >haemorrhages, 9 were due to SBS while the 10th >was a child who was involved in a high speed >Motor vehicle accident. > >The rare Amish disorder is Glutaric aciduria an > inborn error of metabolism that is associated with >developmental delay and epilepsy. The >subarachnoid space is widened due to Cerebral >atrophy making the brain susceptible to minor >trauma. However, Glutaric aciduria does not >explain the presence of the retinal haemorrhages. > >Michael Ryan >Sydney Australia. > >>>> Dipesh Navsaria <> >22/February/1999 12:34pm >>> >Hello again. What follows is not one of our >patients, but a relative of >one of our nurses. As you'll see, there is a lot of >confusion and >questions they have, so I thought I'd throw it out >here to see what people >thought of it. Apologies for any holes in the clinical >data -- I'm >getting this third-hand... > >A one year old male child allegedly fell from his >high chair one evening, >suffering a contusion to the back of the head, >followed closely by a >seizure of unknown duration. The fall was observed >by the child's >stepfather and 8yo older sibling, who later backed >up the story. The >child was transported to the local ER, where the PE >was significant for >the presence of bilateral retinal hemorrhages. A >CT scan revealed two >intercranial bleeds. The child was transported to >the regional tertiary >care center for further care and treatment. He >spent four days as an >inpatient, two days in the PICU and two on the floor. > He was then >discharged. No repeat CT was apparently >obtained. No report was made to >DCFS or law enforcement. He had some >neurological deficits after discharge >and was "relearning" how to use one arm over the >next few weeks. > >Approximately one month later, the child suffered a >second seizure, this >time w/o any apparent precipitating event. The >child's grandmother was >present and noted the child "turning blue". The >stepfather was also in >the house at the time, but his location was known at >all times. The child >was taken to the local ER, transferred to the >regional tertiary care >center again, and a repeat CT obtained. A bleed >was noted in one of the >same locations that the original bleeds had been, >along with shifting of >brain tissue. The child was taken to the OR by >neurosurgery and 50cc >(yes, 50cc) of blood was tapped off. The child >remains an inpatient >today. > >This time, the mother was told that this was from >Shaken Baby Syndrome, >and that the new bleed was from a shaking event >on Friday night. (Even >though there was no shaking event possible by the >stepfather.) She then >was asked to voluntarily sign a form prohibiting >access by the stepfather >and consenting to her own visits with her child to be >observed. She did >so. Two days ago, DCFS stepped in and has >taken temporary custody of the >child and prohibited her to visit. She has requested >to have her child >transferred to a pediatric hospital about two hours >away for a "second >opinion", but this request has been denied by >DCFS, perhaps because the >hospital is out of state. > >The family is confused, hurt, and not sure what's >going on. The mother >doesn't believe that her husband could have done >this, but if he did, she >would have no problems having him prosecuted. >She's not sure why her own >custody of the child has been taken away, and she >feels as if no one is >telling her what is really going on. These are >"simple country folk", so >to speak, and they feel overwhelmed by a system >they don't understand. > >One of the doctors who came into her child's room >(and she has no idea >which one, given that there were so many of them) >told her that it may not >really be Shaken Baby Syndrome but rather some >"Amish Syndrome" that is >"very rare". She has never heard from this doctor >again. > >The questions: > >o Should a CT have been obtained prior to d/c the >first time? > >o How likely is it that a second bleed at the same >location could have >occurred? > >o How can they say this is Shaken Baby Syndrome >so definitively? And why >didn't they say this was the case the first time? >(The tertiary center is >now apparently stating that they thought the local >hospital ER made the >report, and the local ER thought the tertiary center >did.) > >o What is this "Amish Syndrome"? > >If anyone can shed some light on these questions, >I'd appreciate it. I >realize there are a lot of holes in the above story, >but as I said, I'm >receiving this third-hand... > >Peace and Prosperity, >Dipesh > >-<*>------------------------<*>- >Dipesh Navsaria, MPH, PA-C >Physician Assistant, Pediatrics >Champaign & Danville, Illinois >() > > > >Focused email discussion group. >"http://www.pcc.com/lists/"; > To unsubscribe: mail "" >with with "unsubscribe" > > > Focused email discussion group. "http://www.pcc.com/lists/"; > To unsubscribe: mail "" with with "unsubscribe" > > Focused email discussion group. "http://www.pcc.com/lists/"; with with "unsubscribe"