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Brian J. Clark, G. G. W. Adams, Philip J. Luthert, Retinal haemorrhages in infant head injury, Brain, Volume 125, Issue 3, March 2002, Page 677, https://doi.org/10.1093/brain/awf067
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We would like to congratulate Dr Geddes et al. and Brain for publishing their recent valuable contributions to the field of infant head injury/shaken baby syndrome (Geddeset al., 2001a, b). It is unacceptable for malicious child abuse to go undetected and there is an obligation on those looking after children to protect them. However, a refusal to study alternative explanations should not be allowed to unjustly destroy the lives of the accused and their families (Wilkins, 1997). We believe that these papers have important implications for the understanding of retinal haemorrhages in shaken infants.
Prior to Geddes’ papers, consensus strongly supported the hypothesis that in cases of shaking injury, severe shearing forces caused diffuse axonal injury, tears in bridging veins with subdural haemorrhage and retinal hemorrhages (Duhaimeet al., 1998; Ophthalmology Child Abuse Working Party, 1999). The mechanical nature of the suggested mechanism of injury has contributed to the belief that extreme angular accelerational forces are required to generate retinal haemorrhages. These notions are, however, hypothesis and not established fact. The Geddes’ investigations have challenged the importance of diffuse axonal injury and hence shearing forces in the brain and by implication also at the vitreoretinal interface. To date, experimental studies, biomechanical modelling and extrapolations from adult or other forms of paediatric injury have without exception been open to criticism over their relevance to young infants. Biological variation in pathological responses is also rarely given consideration (Wilkins, 1997).
