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Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model
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Retinal Findings in Young Children With Increased Intracranial Pressure From Nontraumatic Causes

Angell Shi1, Abhaya Kulkarni2, Kenneth W Feldman3

  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Pediatrics
|January 12, 2019
PubMed

Insights

Retinal hemorrhages (RHs) are rarely caused by increased intracranial pressure (ICP) in young children, especially without optic disc swelling. This study found no RHs in children with elevated ICP unless papilledema was present.

Area of Science:

  • Ophthalmology
  • Pediatrics
  • Neurology

Background:

  • Increased intracranial pressure (ICP) is a potential consideration in child abuse investigations.
  • Retinal hemorrhages (RHs) have been debated as a potential indicator of ICP in young children.
  • This study investigates the association between ICP and RHs in pediatric patients.

Purpose of the Study:

  • To determine the prevalence and characteristics of retinal hemorrhages (RHs) in children with increased intracranial pressure (ICP).
  • To evaluate whether increased ICP, independent of abusive head trauma, is a cause of RHs in young children.

Main Methods:

  • A prospective, multicenter study included 56 children under 4 years old with newly diagnosed increased ICP requiring intervention.
  • Exclusion criteria included prematurity, neonates, and suspected abusive head trauma based on nonocular findings.
  • Detailed fundus examinations were performed to record the extent, number, and type of RHs in distinct retinal zones.

Main Results:

  • None of the 56 children (0%) studied exhibited retinal hemorrhages (RHs).
  • The causes of increased ICP varied, including hydrocephalus, intraventricular hemorrhage, and congenital malformations.
  • Only one child presented with papilledema, and no RHs were observed in any child or eye.

Conclusions:

  • Retinal hemorrhages (RHs) are rare in children with increased intracranial pressure (ICP) in the absence of papilledema.
  • The findings suggest that RHs associated with ICP, if present, are typically superficial, peripapillary, and linked to optic disc swelling.
Abstract

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