Steven E. Rubin

Head nodding associated with intermittent esotropia.

Head nodding (to-and-fro turning about the vertical cervical axis) associated with abnormal eye movements may be seen in spasmus nutans and congenital nystagmus. In the absence of abnormal eye movements, it may be indicative of neurological disease (eg, cerebellar disease, basal ganglia dysfunction). We report a neurologically normal infant without nystagmus but with intermittent head nodding and intermittent esotropia, whose head movements manifested only when his eyes were straight. The head movements ceased with the occlusion of either eye or spontaneous onset of esotropia. When his head was forcibly stabilized, he immediately developed esotropia. The head movement presumably facilitated fusion, although the mechanism of action is unknown.

Retinal Hemorrhages Go to Court: What Do I Do?

Brian J. Forbes MD, PhD, Alex V. Levin MD, MHSc, FRCSC, Steven Rubin MD The pediatric ophthalmologist plays a key role in the diagnosis of abusive head trauma in children. As Shaken Baby syndrome is a crime, medical professionals are often called upon to testify in family or criminal court. Testimony may be requested by either the prosecution or the defense, yet pediatric ophthalmologists receive little or no preparation and training for this task. Common courtroom debates include the possibility of short falls, causing retinal hemorrhages, vaccine-induced retinal hemorrhage, appropriate diagnostic evaluation, and photographic imaging. Unfamiliarity with courtroom procedure may leave the ophthalmologist feeling as if he is on trial. This workshop will provide the participant with tips on testifying, courtroom procedures, preparation for court, dos and don’ts for the fact and expert witness, and common issues raised by defense and prosecution in retinal hemorrhage cases. Research regarding Shaken Baby syndrome, retinal hemorrhages, as well as medical literature commonly raised for discussion in court will be discussed.