Lee et al. Subacute bacterial endocarditis, anemia or thrombocytope- nia can also lead to retinal hemorrhage, but these can be ruled out by clinical findings such as the results of labora- tory tests (10). Bilateral retinal hemorrhage was found in two of three cases in this report; in neither was there a his- tory of birth trauma, and nor were the laboratory findings remarkable. Conditions which can cause retinal hemor- rhage, such as subacute bacterial endocarditis, anemia or thrombocytopenia, were ruled out by the clinical and labo- ratory findings in all our three cases. Many reports have in- dicated that in the absence of any disease process, retinal hemorrhage is indicative of SBS (1). In case three, fundo- scopic examination was not performed, but a history of child abuse was revealed by the interview with the social worker; adequate counseling of the patient and her family was thus possible. In none of the three cases was there a history of trauma and the infants’ parents or carers did not admit to any physical insults to the patients. Many people do not know, however, that shaking a baby can cause se- vere injury, and thus fail to mention it during history tak- ing; in many instances, unless there is external evidence of injury, a diagnosis of SBS may therefore be delayed or even impossible. In detecting abnormal injuries and sug- gesting to the clinician the possibility of SBS, the radiolo- gist’s role is thus very important and he or she can help prevent further damage due to repeated shaking. In summary, we have described three cases of SBS shown by MRI to be chronic SDH. When radiologists inter- prete the images in cases involving head injuries to young basies, they should bear in mind the possibility of SBS, and by suggesting to the clinician that a particular case may in- volve this and child abuse, may be able to prevent further harm to a patient. References 1. Cox LA. The shaken baby syndrome: diagnosis using CT and MRI. Radiol Tech 1996;67:513-520 2. Petitti N, Williams DW III. CT and MR imaging of nonaccidental pediatric head trauma. Acad Radiol 1998;5:215-223 3. Sato Y, Yuh WTC, Smith WL, Alexander RC, Kao SCS, Ellerbroek CJ. Head injury in child abuse: evaluation with MR imaging. Radiology 1989;173:653-657 4. Duheime AC, Gennarelli TA, Tiubault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome: A clinical, pathologi- cal and biochemical study. J Neurosurg 1987;66:409-415 5. Hearley MN, Sonntag VKH, Rekate HL, Murphy A. The infant whiplash-shake injury syndrome: a clinical and pathologic study. Neurosurgery 1989;24:536-540 6. Couser S. Shaken baby syndrome. J Ped Health Care 1993;7: 238-239 7. Brown GR, Runyan DK. Diagnosing child maltreatment. NC Med J 1994;55:404-408 8. Kleinman PK. Diagnostic imaging in infant abuse. AJR 1990;155:703-712 9. Osborn AG. Diagnostic neuroradiology. St. Louis:Mosby, 1994:205-212 10. Budenz DL, Farber MG, Mirchandani HG, Park H, Rorke LB. Ocular and optic nerve hemorrhages in abused infants with in- tracranial injuries. Ophthalmology 1994;101:559-565 174 Korean J Radiol 2(3), September 2001