Shaken Baby Syndrome

A 4-month-old male infant presents to the emergency department with decreased responsiveness, seizure-like activity, and vomiting following a reported fall from a low sofa. On examination, there is a bulging anterior fontanelle and head circumference crossing two percentile lines upward. CT brain shows bilateral acute subdural haematomas with diffuse cerebral oedema and no skull fracture. Skeletal survey reveals healing posterior rib fractures and metaphyseal lesions. Indirect ophthalmoscopy reveals the pattern marked **A** in the diagram—multilayered haemorrhages extending from the posterior pole to the ora serrata, involving preretinal, intraretinal, and subretinal layers. Which of the following clinical features most strongly supports the diagnosis of abusive head trauma in this case?