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Published on: August 14, 2019
Retinal hemorrhage and brain injury patterns on diffusion-weighted magnetic resonance imaging in children with head
Gil Binenbaum1, Cindy W Christian, Rebecca N Ichord
1Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Ophthalmology, Perelman School of Medicine and the University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
Severe retinal hemorrhages in young children with head trauma are strongly linked to hypoxic-ischemic brain injury (HII). This association was confirmed using diffusion-weighted magnetic resonance imaging (DW-MRI), highlighting the severity of HII in inflicted head injuries.
Area of Science:
- Pediatric Neuroimaging
- Ophthalmology
- Forensic Pathology
Background:
- Head trauma in young children can lead to severe ocular and neurological injuries.
- Distinguishing between accidental and inflicted injuries is crucial for diagnosis and intervention.
- Hypoxic-ischemic brain injury (HII) is a significant complication of head trauma.
Purpose of the Study:
- To investigate the relationship between the severity of retinal hemorrhages and patterns of hypoxic-ischemic brain injury (HII) in young children.
- To utilize diffusion-weighted magnetic resonance imaging (DW-MRI) to assess brain injury patterns.
- To differentiate injury patterns in cases of inflicted versus accidental head trauma.
Main Methods:
- A cohort of children under 3 years with head trauma underwent DW-MRI and eye examinations.
- Two independent masked examiners analyzed DW-MRI for primary traumatic lesions, secondary HII, and mixed injury patterns.
- Retinal hemorrhages were retrospectively graded on a severity scale (1-5).
Main Results:
- A significant association was found between severe retinal hemorrhage (score 3-5) and predominantly post-traumatic HII patterns (P < 0.001).
- Retinal hemorrhage severity positively correlated with HII severity (ρ = 0.53, P < 0.001).
- Severe retinal hemorrhages occurred in inflicted injuries even without HII, suggesting trauma-specific mechanisms.
Conclusions:
- Inflicted head injuries in children can result in a unique trauma type causing global brain injury with HII and more severe retinal hemorrhages.
- Hypoxic-ischemic brain injury is not a prerequisite for severe retinal hemorrhages in inflicted trauma cases.
- DW-MRI findings of HII patterns are strongly associated with retinal hemorrhage severity in pediatric head trauma.
Purpose:
To evaluate associations between retinal hemorrhage severity and hypoxic-ischemic brain injury (HII) patterns by diffusion-weighted magnetic resonance imaging (DW-MRI) in young children with head trauma.
Methods:
DW-MRI images of a consecutive cohort study of children under age 3 years with inflicted or accidental head trauma who had eye examinations were analyzed by two independent masked examiners for type, severity, and location of primary lesions attributable to trauma, HII secondary to trauma, and mixed injury patterns. Retinal hemorrhage was graded retrospectively on a scale from 1 (none) to 5 (severe).
Results:
Retinal hemorrhage score was 3-5 in 6 of 7 patients with predominantly post-traumatic HII pattern and 4 of 32 who had traumatic injury without HII (P < 0.001) on DW-MRI imaging. Severe retinal hemorrhage was observed in absence of HII but only in inflicted injury. Retinal hemorrhage severity was correlated with HII severity (ρ = 0.53, P < 0.001) but not traumatic injury severity (ρ = -0.10, P = 0.50). HII severity was associated with retinal hemorrhage score 3-5 (P = 0.01), but traumatic injury severity was not (P = 0.37).
Conclusions:
During inflicted head injury, a distinct type of trauma occurs causing more global brain injury with HII and more severe retinal hemorrhages. HII is not a necessary factor for severe retinal hemorrhage to develop from inflicted trauma.
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