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Patterns of retinal hemorrhage associated with pediatric cerebral sinovenous thrombosis
Gil Binenbaum1, Julia E Reid1, David L Rogers2
1Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Retinal hemorrhages (RH) are uncommon in pediatric cerebral sinovenous thrombosis (CSVT). When present, RHs in CSVT cases often mimic those caused by other medical conditions, suggesting alternative etiologies.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Cerebral sinovenous thrombosis (CSVT) is a potential cause of retinal hemorrhage (RH) in children.
- This study examines RH prevalence and characteristics in pediatric CSVT cases.
Purpose of the Study:
- To investigate the occurrence and patterns of RH in children diagnosed with CSVT.
- To differentiate RH causes in pediatric CSVT patients.
Main Methods:
- Retrospective review of medical records for children diagnosed with CSVT.
- Fundus examination by an ophthalmologist was a key diagnostic criterion.
Main Results:
- Only 17% of pediatric CSVT patients exhibited RH.
- RH patterns observed were consistent with conditions like raised intracranial pressure and sepsis.
- Optic disc swelling was present in 62% of the children.
Conclusions:
- RH is infrequent in pediatric CSVT and often secondary to other medical issues.
- Specific RH characteristics (multilayered, extensive, or without disc swelling) warrant investigation for alternative causes beyond CSVT.
Background:
Cerebral sinovenous thrombosis (CSVT) has been proposed as an alternative cause of retinal hemorrhage (RH) in children being evaluated for abusive head trauma. This study investigated the prevalence and characteristics of RH in children with CSVT.
Methods:
The medical records of children >6 weeks of age with newly diagnosed CSVT and fundus examination by an ophthalmologist were examined retrospectively. Primary outcomes were presence and patterns of RH.
Results:
A total of 29 children (median age, 9 years; range, 7 weeks to 17 years) were studied. Of these, 5 (17%) had RH, in 4 of whom RH were peripapillary, superficial, intraretinal, and adjacent to a swollen optic disk. In the fifth child, who had meningitis, sepsis, and multiple cerebral infarcts, there were a moderate number of posterior pole intraretinal hemorrhages. Eighteen children (62%) had optic disk swelling. In 13 children, cerebrospinal fluid opening pressure was recorded (range, 27-59 cm H2O). CSVT risk factors included meningitis, mastoiditis, and hypercoagulability.
Conclusions:
RH in pediatric CSVT was uncommon. When RHs were present, the appearance matched RH patterns known to be caused by medical conditions, such as raised intracranial pressure and sepsis, also present in these children. These findings suggest that the RHs are due to these other causes and not directly to CSVT itself. In children with CSVT, if RHs are multilayered, extend beyond the peripapillary region into the rest of the posterior pole or retinal periphery, or occur in the absence of optic disk swelling, another etiology for the RH should be sought.
