Circumpapillary Retinal Ridge in the Shaken-Baby Syndrome

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     To the Editor: The discussion in Images in Clinical Medicine by Hylton and Goldberg (July 8 issue)1 implies that the circumpapillary retinal ridge is pathognomonic for the shaken-baby syndrome. This belief was widely held among ophthalmologists, pediatricians, and forensic pathologists until it was recently challenged.2,3 Two studies used a process associated with evidence-based medicine to evaluate the premise that the perimacular retinal fold is diagnostic of shaken-baby syndrome. Both studies found that such a presupposition was not supported by solid scientific evidence. Since a diagnosis of shaken-baby syndrome can lead to serious consequences, doctors should be cautious when using the circumpapillary retinal ridge as the sole criterion for this diagnosis.

    Kittisak Kulvichit, M.D.

    Chulalongkorn University

    Bangkok 10330, Thailand

    kittisak.k@chula.ac.th

    References

    Hylton C, Goldberg MG. Circumpapillary retinal ridge in the shaken-baby syndrome. N Engl J Med 2004;351:170-170.

    Donohoe M. Evidence-based medicine and shaken-baby syndrome: part I: literature review, 1966-1998. Am J Forensic Med Pathol 2003;24:239-242.

    Lantz PE, Sinal SH, Stanton CA, Weaver RG Jr. Perimacular retinal folds from childhood head trauma. BMJ 2004;328:754-756.

    http://www.100md.com/html/DirDu/2006/11/29/30/67/57.htm