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Raised intracranial pressure and retinal haemorrhages in childhood encephalopathies
Robert A Minns1, Patricia A Jones1, Anamika Tandon2
1Department Child Life and Health, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
Insights
Raised intracranial pressure (RICP) is linked to retinal hemorrhages in children with encephalopathy. While RICP correlates with the presence and number of intraretinal hemorrhages, specific pressure levels did not significantly alter occurrence.
Area of Science:
- Pediatric Ophthalmology
- Neurology
- Trauma Research
Background:
- Childhood encephalopathies, both traumatic and non-traumatic, can lead to raised intracranial pressure (RICP).
- Retinal hemorrhages are a potential indicator of neurological injury in children, but their precise relationship with RICP requires further elucidation.
Purpose of the Study:
- To investigate the association between raised intracranial pressure (RICP) and the presence, characteristics, and quantity of retinal hemorrhages in children.
- To differentiate the relationship in traumatic versus non-traumatic encephalopathies.
Main Methods:
- A prospective study involving 112 children with accidental traumatic brain injuries (ATBIs), inflicted traumatic brain injuries (ITBIs), and non-traumatic encephalopathies.
- Intracranial pressure (ICP), cerebral perfusion pressure, and ICP pressure-time index were measured.
- Retinal imaging was used to assess the number, zone, and layer of retinal hemorrhages.
Main Results:
- Retinal hemorrhages were present in 38% of children with elevated or clinically suspected RICP.
- The presence of RICP was significantly associated with retinal hemorrhages, independent of age and etiology.
- While the number of intraretinal hemorrhages (nerve-fiber layer, dot blot) was higher in the RICP group, overall numbers and occurrence were not significantly related to specific ICP levels.
Conclusions:
- A complex relationship exists between RICP and retinal hemorrhages in childhood encephalopathies.
- No evidence suggests that RICP exacerbates existing or causes new retinal hemorrhages during periods of confirmed elevated pressure.
Aim:
To explore the relationship between raised intracranial pressure (RICP) and retinal haemorrhages in traumatic and non-traumatic childhood encephalopathies.
Method:
A prospective study of 112 children (35 females and 77 males, age range 0.01mo-17y 8.3mo; mean 5y 8.6mo, median 4y 5.6mo) included 57 accidental traumatic brain injuries (ATBIs), 21 inflicted traumatic brain injuries (ITBIs), and 34 non-traumatic encephalopathy cases. Measurements included intracranial pressure (ICP), cerebral perfusion pressure, pressure-time index of ICP, and number, zone, and layer of retinal haemorrhages on retinal imaging.
Results:
Group I had measured elevated ICP (n=42), Group II had clinical and/or radiological signs of RICP (n=21), and Group III had normal ICP (n=49). In the combined Groups I and II, 38% had retinal haemorrhages. Multiple logistic regression confirmed that the presence of retinal haemorrhages was significantly related to the presence of RICP independent of age and aetiology; however, the occurrence and overall numbers were not significantly related to the specific ICP level. The numbers of intraretinal (nerve-fibre layer and dot blot) retinal haemorrhages were significantly greater in those with RICP. The ITBI population was significantly different from the other combined aetiological categories.
Interpretation:
The study results indicate a complex RICP/retinal haemorrhage relationship. There was no evidence of existing retinal haemorrhages being exacerbated or new retinal haemorrhages developing during periods of confirmed RICP.