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Retinal hemorrhage asymmetry in inflicted head injury: a clue to pathogenesis?

Elizabeth E Gilles1, Mary Lou McGregor, Grace Levy-Clarke

  • 1Departments of Pediatrics and Neurology, Division of Pediatric Neurology, MMC 486, 420 Delaware Street SE, University of Minnesota, MN 55455, USA. gille037@tc.umn.edu

The Journal of Pediatrics
|October 23, 2003
PubMed

Insights

Retinal hemorrhages in inflicted head injury correlate with brain injury patterns. Asymmetry in retinal hemorrhages often indicates the side with the most severe cerebral injury in children.

Area of Science:

  • Neuroscience
  • Ophthalmology
  • Pediatric Traumatology

Background:

  • Inflicted head injury in children can cause severe neurological damage.
  • Retinal hemorrhages are a common finding in abusive head trauma.
  • Understanding the correlation between brain injury and retinal findings is crucial for diagnosis.

Purpose of the Study:

  • To investigate the relationship between regional patterns of cerebral parenchymal injury and the distribution of retinal hemorrhages.
  • To determine if brain injury patterns can predict the location of retinal hemorrhages in inflicted head injuries.

Main Methods:

  • Retrospective case series of 14 children with confirmed inflicted head injury.
  • Analysis of funduscopic photographs and serial computerized tomographic (CT) imaging.
  • Assessment of Retinal Hemorrhage Score, visual fields, and CT/necropsy findings.

Main Results:

  • Retinal hemorrhages were present in 71% of children, predominantly asymmetric (90%).
  • Maximal retinal hemorrhages often occurred on the side of greatest cerebral injury.
  • Imaging asymmetry predicted retinal hemorrhage distribution in survivors; early ophthalmoscopy improved asymmetry detection.

Conclusions:

  • The distribution of retinal hemorrhages correlates with acute and evolving regional cerebral parenchymal injury patterns in inflicted head injuries.
  • This correlation aids in understanding the pathophysiology and diagnosis of abusive head trauma.
Abstract

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