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Retinal haemorrhages in a university hospital: not always abusive head injury
M Mattheij1, C Venstermans2, I de Veuster3
1Department of Neurology - Paediatric Neurology, Antwerp University Hospital, University of Antwerp, Wijlrijkstraat 10, 2610, Edegem, Belgium. marjolein.mattheij@uza.be.
Insights
Retinal haemorrhages (RH) and subdural haematomas (SDH) are not always indicative of abusive head trauma (AHT). While suggestive, other factors and imaging can help differentiate AHT cases from other causes in infants.
Area of Science:
- Pediatric Ophthalmology
- Pediatric Neuroradiology
- Child Abuse Pediatrics
Background:
- Retinal haemorrhages (RH) and subdural haematomas (SDH) are commonly observed in abusive head trauma (AHT).
- These findings are suggestive but not definitively diagnostic of AHT.
Purpose of the Study:
- To evaluate the diagnostic utility of RH and SDH in identifying AHT.
- To explore differentiating factors between AHT and non-AHT cases presenting with RH.
Main Methods:
- Observational retrospective study of 29 infants (1-18 months) admitted with RH.
- Data collection included clinical history, examination, imaging (including diffusion-weighted MRI), and social evaluations.
- Comparison of findings between infants suspected of AHT and those not suspected.
Main Results:
- Twenty-three of 29 infants were suspected of AHT; 6 were not.
- Among non-suspect cases, 2 had identified etiologies, and 4 had no clear cause but showed accelerated head circumference growth.
- RH characteristics (location, distribution, size) did not differ significantly between suspect and non-suspect groups.
Conclusions:
- RH and SDH in infants are not pathognomonic for AHT.
- Cerebral imaging and detailed retinal findings aid in differentiating AHT from other causes.
- Accelerated head circumference growth may be a predisposing factor for RH/SDH in non-AHT cases.
Abstract:
Retinal haemorrhages (RH) and subdural haematomas (SDH) are frequently seen in abusive head trauma (AHT). The aim of our study is to show that they are suggestive, but not pathognomonic for AHT. We performed an observational retrospective study on children, aged 1-18 months old, admitted to the Antwerp University Hospital with RH. History, physical examination, medical course, coagulation and metabolic tests, skeletal survey, head circumference, retinal findings, cerebral imaging, and evaluation reports by social services or civil/criminal courts were collected. Twenty-nine children with RH were included. Twenty three of them were found suspect of AHT. Three children of this group showed intraparenchymal haematomas/infarctions, 5 interhemispheric blood, 6 cerebral oedema, 7 ventricle compression, and 4 papilloedema. Seven of the 16 children with diffusion-weighted MRI images showed diffuse lesions. In 2 of the 6 children not suspect for AHT, an aetiology was found. None of the 4 remaining children showed the above-mentioned abnormalities. Three of these 4 cases showed an accelerated growth of the head circumference months before presentation. The majority of the children in all groups showed 'too numerous to count' (>20) RH (12 of the 23 'suspect' children, and 4 of the 6 'non-suspect' children). Results showed no differences between the groups concerning the location, distribution, or size of the RH. Infants with RH and/or SDH are not necessarily victims of AHT. Cerebral imaging and retinal findings can help differentiate suspect from non-suspect cases. Infants with a large head circumference could be predisposed to RH or SDH.
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