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Patterns of retinal hemorrhage associated with increased intracranial pressure in children

Gil Binenbaum1, David L Rogers, Brian J Forbes

  • 1Division of Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. binenbaum@email.chop.edu

Pediatrics
|July 24, 2013
PubMed

Insights

Retinal hemorrhages (RHs) are uncommon in children with elevated intracranial pressure (ICP) without trauma. When RHs occur, they are linked to significantly high ICP and appear near a swollen optic disc, differing from trauma-related patterns.

Area of Science:

  • Ophthalmology
  • Pediatrics
  • Neurology

Background:

  • Elevated intracranial pressure (ICP) is a suspected cause of retinal hemorrhages (RHs) in pediatric head trauma.
  • This study investigates RHs in children with elevated ICP but no history of trauma.

Purpose of the Study:

  • To determine the incidence and patterns of RHs in children with elevated ICP measured by lumbar puncture (LP) in the absence of trauma.
  • To differentiate RH patterns associated with non-traumatic elevated ICP from those seen in abusive head trauma.

Main Methods:

  • Prospective and retrospective study of 100 children undergoing LP for routine care.
  • Inclusion criteria: no trauma, LP opening pressure (OP) ≥ 20 cm H2O, and ophthalmological examination.
  • Data collected on OP, etiology, papilledema, and presence/pattern of RHs.

Main Results:

  • 16 of 100 children (16%) had RHs, all with significantly elevated OP (mean 42 cm H2O).
  • RHs were superficial intraretinal peripapillary or splinter hemorrhages directly on a swollen optic disc.
  • Idiopathic intracranial hypertension was the most frequent etiology (70%); 74% had papilledema.

Conclusions:

  • Retinal hemorrhages are infrequent in children with non-traumatic elevated ICP.
  • When present, RHs in this context are associated with markedly elevated OP and a specific peripapillary pattern near optic disc swelling.
  • Widespread or peripheral RHs not near optic disc swelling suggest elevated ICP alone is unlikely the cause.
Abstract

Keywords:
intracranial pressurepapilledemaretinal hemorrhage

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