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Abstract
Case summary
An 8-month-old male infant presented to the emergency room with decreased consciousness and epileptic seiz-ures that the parents attributed to a fall from a chair. He had no external wounds or fractures to the skull or elsewhere. However, computerized tomography of the brain revealed an acute subdural hematoma in the right cranial convexity and diffuse cerebral edema, leading to a midline shift to the left and effacement of the right lateral ventricle and basal cistern. The attending neuro-surgeon promptly administered a decompressive craniectomy. Immediately after the emergency surgery, a fundus examination revealed numerous multilayered retinal hemorrhages in the posterior pole extending to the periphery in each eye. He also had white retinal ridges with cherry hemorrhages in both eyes. We acquired retinal photographs using the native camera of a smartphone in video mode. The photographer held the smartphone with one hand, facing the patient's eye at 15–20 cm, and held a 20 diopter condensing lens at 5 cm from the eye in the other hand. Our documentation using a smartphone led to a diagnosis of abusive head trauma and to obtain the criminal's confession, because the findings were specific for repetitive acceleration-deceleration forces to an infant's eye with a strong vitreoretinal attachment.
References
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Figure 1.
Clinical photography, computed tomography (CT) scan of the brain, smartphone photographs of the fundus, and cross-section of gross examination on autopsy. (A) Absence of external signs of ocular trauma, but presence of a pale-blue eyelid margin. (B) CT scan showing subdural hemorrhage at the right cranial convexity with a midline shift to the left, and effacement of the right lateral ventricle and basal cistern. (C) Protruded swollen brain after decompressive craniectomy. (D, E) Smartphone photographs of the fundus, showing numerous multilayered retinal hemorrhages and a portion of a white retinal ridge (asterisk) with a cherry hemorrhage (white arrow) in the right eye (D) and the left eye (E). (F) Hemorrhages inside the dural sheath of the optic nerve (arrowheads) and cherry retinal hemorrhages (red arrows) in both eyes.
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