Talbert DG
Introduction: Retinopathy forms an important component of the “Triad” of injuries in infants currently considered evidence of imposed trauma. Injuries are assumed to be due to physical shaking of the whole body of the infant. However, Valsalva Retinopathy produces the same injuries by cerebral venous hypertension in a different discipline, Ophthalmology.
Examples: Examples of Valsalva Retinopathy injuries are given, involving degrees of stress varying from weightlifting to playing the trombone and blowing up party balloons. These examples show vulnerability to excessive intraabdominal pressure varies between individuals. All these examples are in adults in whom shaking could not have occurred.
Mechanism: The fundamental hazard in Valsalva Retinopathy is Venous Hypertension caused by raised thoracoabdominal pressure from any cause. In infants this is most likely to occur during violent vomiting. In most individuals the brain is protected from excessive Superior Vena Cava pressure by valves in the inner jugular veins. In infants where these valves are defective, or even absent, any excessive venous pressure will be applied directly to the cerebral venous system. Susceptibility will depend on the development of the inner jugular vein valves in each particular case.
Conclusions: Retinal hemorrhages are not unique to SBS. Evidence of the findings of retinal haemorrhages is not “powerful supporting evidence of shaking” because similar injuries are known to result from Valsalva Retinopathy. The Retinopathy component of the triad is invalid in its present form, rendering the Triad itself valueless in court.
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