Carter J E, McCormick A Q
Child Abuse Negl. 1983;7(3):279-86. doi: 10.1016/0145-2134(83)90005-4.
Three cases of whiplash shaking injury of infants are presented. All children presented with seizures and had minimal signs of external injury. Examination of the retina revealed extensive retinal hemorrhages. These were missed on initial examination and were only discovered after pupillary dilatation. The presence of these palecentered retinal hemorrhages suggested the diagnosis of child abuse and skeletal surveys and thorough social histories confirmed the diagnosis. Despite extensive retinal hemorrhages, computerized axial tomography (C.T.) scan showed minimal inter-hemispheric bleeding. In contrast to the "Battered Child Syndrome," all the findings in whiplash shaking syndrome of infants are subtle and demand an awareness, an index of suspicion and a thorough examination which may include extensive retinal examination following dilatation of the pupils. This latter examination is frequently not performed by family physicians and residents so that the syndrome may be missed. A fourth case is also discussed where shaking is admitted on initial presentation but said to be done for resuscitation. This poses an immense diagnostic dilemma to the pediatrician since in this case the child presented later with all the signs of physical abuse.
本文报告了3例婴儿挥鞭样摇晃损伤的病例。所有患儿均出现癫痫发作，且体表损伤迹象轻微。视网膜检查发现广泛的视网膜出血。这些出血在初次检查时被漏诊，仅在瞳孔散大后才被发现。这些以苍白为中心的视网膜出血提示存在虐待儿童的可能，骨骼检查和全面的社会史调查证实了这一诊断。尽管存在广泛的视网膜出血，但计算机断层扫描（CT）显示半球间出血极少。与“受虐儿童综合征”不同，婴儿挥鞭样摇晃综合征的所有表现都很细微，需要提高警惕、保持怀疑并进行全面检查，这可能包括瞳孔散大后的广泛视网膜检查。家庭医生和住院医师常常不进行后一项检查，因此该综合征可能会被漏诊。本文还讨论了第4个病例，该患儿初次就诊时承认有摇晃行为，但称是为了进行复苏。这给儿科医生带来了巨大的诊断难题，因为在这个病例中，患儿后来出现了所有身体虐待的迹象。
