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Retinal and subdural haemorrhages from minor falls?
  1. Anuradha Ganesh1,
  2. Derek Stephens2,
  3. Jane D Kivlin3,
  4. Alex V Levin4
  1. 1Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
  2. 2Population Health Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  4. 4Departments of Paediatrics and Ophthalmology and Vision Science, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to: Dr A V Levin Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, M158 Toronto, Ontario, Canada M5G 1X8; alex.levin{at}sickkids.ca

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Retinal and subdural haemorrhages with or without occult bone fractures in children aged <3 years is a characteristic presentation of the shaken baby syndrome (SBS) with or without blunt head impact.1–3 The signs may pose diagnostic dilemmas resulting from an inconsistent history given by the child’s caretakers and the frequent absence of evidence of external injury. Accidental blunt impact that leads to subdural haemorrhage is usually associated with significant trauma, skull fractures and only rare cases of retinal haemorrhage. There is abundant evidence that minor head trauma, in the absence of underlying medical conditions such as osteogenesis imperfecta type I,4 is only very rarely associated with severe intracranial injury or retinal haemorrhage, particularly the extensive multilayered haemorrhages extending to the ora serrata, as seen in two thirds of the victims with SBS.1–3,5

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