Letters to the Editor
a
this feature may be fixation artifact or bilateral cortical representation, and the most accepted theory of vascular occlusive lesions in the macula source from the region of the middle cerebral artery.[2] Homonymous hemianopia is caused most commonly by cerebral artery infarction. Posterior cerebral artery infarcts represent about 5% to 10% of all strokes in a general population. [3] Visual acuity is not affected unless there exists a bilateral lesion. Hemianopia placed behind the chiasm lesions show different features. Visual field defects are usually permanent defects.
b
Figure 2: Occipital encephalomalacia at cerebral magnetic resonance imaging
Ali Akal, Tugba Goncu, Nurefsan Boyaci1, Bahattin Celik2, Ozcan Kocaturk3
In the history there was no trauma, surgical intervention and birth asphyxia. In the eye examination, ‑1.75 myopic refractive errors were present bilaterally. The best corrected visual acuity was 1.0 bilaterally. Partial optic pallor was present in both eyes at fundus examination. Slit‑lamp examination and intraocular pressure were normal. Homonymous quadrantanopia was determined at the peripheral visual field examination with threshold 30‑2 test [Figure 1]. Findings consistent with occipital encephalomalacia have been reported on cerebral magnetic resonance imaging [Figure 2]. Occipital encephalomalacia diagnosis was confirmed at pediatric neurology consultation. Laboratory studies were normal. Any pathological findings required to be treated were not detected at systemic examination. Due to unilateral lesion, not affecting vision, and lack of systemic clinical manifestations it was considered that it occurred after vascular events. The patient is under periodic control for 3 years as signs and symptoms did not change.
Departments of Ophthalmology, 1Radiology, 2Neurosurgery, 3Neurology, Harran University Medical School, Sanliurfa, Turkey Address for correspondence: Dr. Ali Akal, Department of Ophthalmology, Faculty of Medicine, Harran University Medical School, Sanliurfa - 63300, Turkey. E-mail: [email protected]
REFERENCES 1. 2. 3.
Trobe JD, Lorber ML, Schlezinger NS. Isolated homonymous hemianopia. A review of 104 cases. Arch Ophthalmol 1973; 89:377‑81. Hoyt WF, Newton TH. Angiographic changes with occlusion of arteries that supply the visual cortex. NZ Med J 1970;72:310‑6. Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR. Posterior cerebral artery territory infarcts: Clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. Cerebrovasc Dis 2000;10:170‑82. Access this article online
Website: www.ijciis.org
Quick Response Code:
DOI: 10.4103/2229-5151.152353
The most prominent features of the occipital lobe lesions are symmetrical contralateral homonymous hemianopia and central (macular) vision is preserved in most of them. Despite the existence of views that reason for
Child‑witnessed domestic violence: An epidemic in the shadows Dear Editor, Your esteemed journal does great credit to critical care, emergency medicine, surgery, trauma and burn; however, we would like to highlight a very different aspect of injury that occupies a prominent role internationally, but is often ignored; and that is the arena of child‑witnessed domestic violence (DV).[1] A staggering 35‑50% of households that experience domestic violence between partners have 64
children. [2] Consequently, there are as many as 275 million children who are exposed to household violence worldwide. [3] Indeed, the above estimate is probably quite conservative because many countries simply do not maintain statistical record in this regard. To add to the true proportion of this problem, children who are exposed to violence in the home are 15 more times as likely to be physically or sexually abused; and this cycle can be continued from generation to generation.[3]
International Journal of Critical Illness and Injury Science | Vol. 5 | Issue 1 | Jan-Mar 2015
Letters to the Editor
It has been well documented that child‑witnessed DV leads to changes in the development of the brain, both anatomically and physiologically, and subsequently impairs affected individuals’ ability to respond appropriately to social situations and impairs their ability to deal with even minor challenges throughout their lifetime. [4,5] It is critical to understand that child‑witnessed DV is a form of child maltreatment. There are two categories of maltreatment: Acts of commission and acts of omission. Both forms of maltreatment result in altered neuroimaging characteristics and physiologic alteration. [4,5] Acts of commission are acts that are intentionally intended against the child whereas acts of omission involve failed care or neglect. The ensuing difficulties encompass behavioral, social and emotional difficulties, cognitive and attitudinal problems, and other long‑term problems or adjustments.[1] Neurobiological changes seen among children witnessing DV include abnormalities in the midbrain, the limbic system, cortex, corpus callosum, and cerebellum. Their importance can be outlined as follows. The midbrain is the “relay point” for changes or messaging in sight and hearing. The limbic system (amygdala, hippocampus, hypothalamus) houses the centers for emotion, survival, fear, anger, and pleasure, including sex. It is also important for memory information and storage, as well as being involved in the weight of the individual’s response. The cortex houses executive functions, and the comprehension of consequences, and the corpus callosum allows both sides of brain to communicate in regard to hearing, sight, and cognition. The corpus callosum is the largest concentrated collection of white matter in the brain and connects both cerebral hemispheres thereby facilitating intra‑cerebral communication. Finally, the cerebellum is involved in balance, emotion and cognitive development. These structures and the resultant pathways of response are altered following child‑witnessed DV.[4,5]
nursing, trauma, emergency, surgery, critical care, and anesthesiology professionals, is that the simple act of witnessing domestic violence is sufficient to cause changes in brain anatomy and thereby signaling pathways that lead to maladaptive responses for the entirety of a child’s life. We believe that child‑witnessed DV merits wider consideration for inclusion as a topic in any future conferences that involve trauma and emergency medicine in which our colleagues and readers endeavor to convene. Areti Tsavoussis, Stanislaw PA Stawicki1, Thomas J Papadimos2
Department of Witness Assistance, Lucas County Government, Office of the Prosecutor, Toledo, 1Departments of Surgery and 2Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA Address for correspondence: Dr. Thomas J Papadimos, Department of Anesthesiology, Wexner Medical Center, The Ohio State University, 410 West, 10th Avenue, Room‑417C, Doan Hall, Columbus, Ohio ‑ 43210, USA. E‑mail: [email protected]
REFERENCES 1.
2. 3. 4. 5.
Abramsky T, Watts CH, Garcia‑Moreno C, Devries K, Kiss L, Ellsberg M, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi‑country study on women’s health and domestic violence. BMC Public Health2011;11:109. Domestic Violence and the Child Welfare System. Available from: http:// www.childwelfare.gov. [Last accessed on 2014 Feb 12]. Behind Closed Doors. The Impact of Domestic Violence on Children. Available from: http://www.unicef.org/protection/files/ BehindClosedDoors.pdf. [Last accessed on 2014 Feb 12]. Delima J, Vimpani G. The neurobiological effects of childhood maltreatment. Fam Matters 2011;89:42‑52. Carrion VG, Wong SS, Kletter H. Update on neuroimaging and cognitive functioning in maltreatment‑related pediatric PTSD: Treatment implications. J Fam Violence 2013;28:53‑61. Access this article online
Website: www.ijciis.org
Quick Response Code:
DOI: 10.4103/2229-5151.152354
The primary point to be made to the journal readership, which is comprised of a countless number of caring
A crying shame: Battered baby Dear Editor, Battered baby is a victim of deliberate nonaccidental physical trauma that has been inflicted by a person responsible for the care of the baby.[1] There is a complex interaction of psychopathological, social, and legal aspects.[2] The index case reported here is a 12‑month‑old female infant who was brought with complaints of persistent inconsolable crying and decreased oral
acceptance. On examination, she was irritable and afebrile, with stable vital parameters. There were no external signs of injury. Systemic examination was within normal limits. A meticulous history taken from the parents raised the suspicion of foreign body ingestion, and hence, chest and abdomen radiographs were requested. Surprisingly, the abdominal X‑ray revealed two sharp pointed radioopaque objects akin to all pins [Figure 1a]. Thereafter, the infant
International Journal of Critical Illness and Injury Science | Vol. 5 | Issue 1 | Jan-Mar 2015
65
Copyright of International Journal of Critical Illness & Injury Science is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
a
this feature may be fixation artifact or bilateral cortical representation, and the most accepted theory of vascular occlusive lesions in the macula source from the region of the middle cerebral artery.[2] Homonymous hemianopia is caused most commonly by cerebral artery infarction. Posterior cerebral artery infarcts represent about 5% to 10% of all strokes in a general population. [3] Visual acuity is not affected unless there exists a bilateral lesion. Hemianopia placed behind the chiasm lesions show different features. Visual field defects are usually permanent defects.
b
Figure 2: Occipital encephalomalacia at cerebral magnetic resonance imaging
Ali Akal, Tugba Goncu, Nurefsan Boyaci1, Bahattin Celik2, Ozcan Kocaturk3
In the history there was no trauma, surgical intervention and birth asphyxia. In the eye examination, ‑1.75 myopic refractive errors were present bilaterally. The best corrected visual acuity was 1.0 bilaterally. Partial optic pallor was present in both eyes at fundus examination. Slit‑lamp examination and intraocular pressure were normal. Homonymous quadrantanopia was determined at the peripheral visual field examination with threshold 30‑2 test [Figure 1]. Findings consistent with occipital encephalomalacia have been reported on cerebral magnetic resonance imaging [Figure 2]. Occipital encephalomalacia diagnosis was confirmed at pediatric neurology consultation. Laboratory studies were normal. Any pathological findings required to be treated were not detected at systemic examination. Due to unilateral lesion, not affecting vision, and lack of systemic clinical manifestations it was considered that it occurred after vascular events. The patient is under periodic control for 3 years as signs and symptoms did not change.
Departments of Ophthalmology, 1Radiology, 2Neurosurgery, 3Neurology, Harran University Medical School, Sanliurfa, Turkey Address for correspondence: Dr. Ali Akal, Department of Ophthalmology, Faculty of Medicine, Harran University Medical School, Sanliurfa - 63300, Turkey. E-mail: [email protected]
REFERENCES 1. 2. 3.
Trobe JD, Lorber ML, Schlezinger NS. Isolated homonymous hemianopia. A review of 104 cases. Arch Ophthalmol 1973; 89:377‑81. Hoyt WF, Newton TH. Angiographic changes with occlusion of arteries that supply the visual cortex. NZ Med J 1970;72:310‑6. Brandt T, Steinke W, Thie A, Pessin MS, Caplan LR. Posterior cerebral artery territory infarcts: Clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature. Cerebrovasc Dis 2000;10:170‑82. Access this article online
Website: www.ijciis.org
Quick Response Code:
DOI: 10.4103/2229-5151.152353
The most prominent features of the occipital lobe lesions are symmetrical contralateral homonymous hemianopia and central (macular) vision is preserved in most of them. Despite the existence of views that reason for
Child‑witnessed domestic violence: An epidemic in the shadows Dear Editor, Your esteemed journal does great credit to critical care, emergency medicine, surgery, trauma and burn; however, we would like to highlight a very different aspect of injury that occupies a prominent role internationally, but is often ignored; and that is the arena of child‑witnessed domestic violence (DV).[1] A staggering 35‑50% of households that experience domestic violence between partners have 64
children. [2] Consequently, there are as many as 275 million children who are exposed to household violence worldwide. [3] Indeed, the above estimate is probably quite conservative because many countries simply do not maintain statistical record in this regard. To add to the true proportion of this problem, children who are exposed to violence in the home are 15 more times as likely to be physically or sexually abused; and this cycle can be continued from generation to generation.[3]
International Journal of Critical Illness and Injury Science | Vol. 5 | Issue 1 | Jan-Mar 2015
Letters to the Editor
It has been well documented that child‑witnessed DV leads to changes in the development of the brain, both anatomically and physiologically, and subsequently impairs affected individuals’ ability to respond appropriately to social situations and impairs their ability to deal with even minor challenges throughout their lifetime. [4,5] It is critical to understand that child‑witnessed DV is a form of child maltreatment. There are two categories of maltreatment: Acts of commission and acts of omission. Both forms of maltreatment result in altered neuroimaging characteristics and physiologic alteration. [4,5] Acts of commission are acts that are intentionally intended against the child whereas acts of omission involve failed care or neglect. The ensuing difficulties encompass behavioral, social and emotional difficulties, cognitive and attitudinal problems, and other long‑term problems or adjustments.[1] Neurobiological changes seen among children witnessing DV include abnormalities in the midbrain, the limbic system, cortex, corpus callosum, and cerebellum. Their importance can be outlined as follows. The midbrain is the “relay point” for changes or messaging in sight and hearing. The limbic system (amygdala, hippocampus, hypothalamus) houses the centers for emotion, survival, fear, anger, and pleasure, including sex. It is also important for memory information and storage, as well as being involved in the weight of the individual’s response. The cortex houses executive functions, and the comprehension of consequences, and the corpus callosum allows both sides of brain to communicate in regard to hearing, sight, and cognition. The corpus callosum is the largest concentrated collection of white matter in the brain and connects both cerebral hemispheres thereby facilitating intra‑cerebral communication. Finally, the cerebellum is involved in balance, emotion and cognitive development. These structures and the resultant pathways of response are altered following child‑witnessed DV.[4,5]
nursing, trauma, emergency, surgery, critical care, and anesthesiology professionals, is that the simple act of witnessing domestic violence is sufficient to cause changes in brain anatomy and thereby signaling pathways that lead to maladaptive responses for the entirety of a child’s life. We believe that child‑witnessed DV merits wider consideration for inclusion as a topic in any future conferences that involve trauma and emergency medicine in which our colleagues and readers endeavor to convene. Areti Tsavoussis, Stanislaw PA Stawicki1, Thomas J Papadimos2
Department of Witness Assistance, Lucas County Government, Office of the Prosecutor, Toledo, 1Departments of Surgery and 2Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA Address for correspondence: Dr. Thomas J Papadimos, Department of Anesthesiology, Wexner Medical Center, The Ohio State University, 410 West, 10th Avenue, Room‑417C, Doan Hall, Columbus, Ohio ‑ 43210, USA. E‑mail: [email protected]
REFERENCES 1.
2. 3. 4. 5.
Abramsky T, Watts CH, Garcia‑Moreno C, Devries K, Kiss L, Ellsberg M, et al. What factors are associated with recent intimate partner violence? Findings from the WHO multi‑country study on women’s health and domestic violence. BMC Public Health2011;11:109. Domestic Violence and the Child Welfare System. Available from: http:// www.childwelfare.gov. [Last accessed on 2014 Feb 12]. Behind Closed Doors. The Impact of Domestic Violence on Children. Available from: http://www.unicef.org/protection/files/ BehindClosedDoors.pdf. [Last accessed on 2014 Feb 12]. Delima J, Vimpani G. The neurobiological effects of childhood maltreatment. Fam Matters 2011;89:42‑52. Carrion VG, Wong SS, Kletter H. Update on neuroimaging and cognitive functioning in maltreatment‑related pediatric PTSD: Treatment implications. J Fam Violence 2013;28:53‑61. Access this article online
Website: www.ijciis.org
Quick Response Code:
DOI: 10.4103/2229-5151.152354
The primary point to be made to the journal readership, which is comprised of a countless number of caring
A crying shame: Battered baby Dear Editor, Battered baby is a victim of deliberate nonaccidental physical trauma that has been inflicted by a person responsible for the care of the baby.[1] There is a complex interaction of psychopathological, social, and legal aspects.[2] The index case reported here is a 12‑month‑old female infant who was brought with complaints of persistent inconsolable crying and decreased oral
acceptance. On examination, she was irritable and afebrile, with stable vital parameters. There were no external signs of injury. Systemic examination was within normal limits. A meticulous history taken from the parents raised the suspicion of foreign body ingestion, and hence, chest and abdomen radiographs were requested. Surprisingly, the abdominal X‑ray revealed two sharp pointed radioopaque objects akin to all pins [Figure 1a]. Thereafter, the infant
International Journal of Critical Illness and Injury Science | Vol. 5 | Issue 1 | Jan-Mar 2015
65
Copyright of International Journal of Critical Illness & Injury Science is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
