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Published on: September 11, 2013
[Retinal hemorrhages in abusive head trauma]
Kerstin Hellgren1, Kristina Fahnehjelm2
1docent, överläkare , institutionen för klinisk neurovetenskap, Karolinska institutet; PF Barnneurologi och barnneurokirurgi, Tema barn och kvinnosjukvård, Karolins-ka universitetssjukhuset, Stockholm.
Insights
Abusive head trauma (AHT) in infants often causes retinal hemorrhages (RH), a key indicator. Specific patterns of RH, especially when combined with brain injury, strongly suggest AHT in young children.
Area of Science:
- Ophthalmology
- Pediatrics
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a significant cause of infant brain injury, often underdiagnosed.
- Retinal hemorrhages (RH) are a hallmark symptom of AHT, second only to childbirth as a cause in infants.
- Retinoschisis, with or without retinal folds, is highly indicative of AHT and not associated with childbirth.
Purpose of the Study:
- To highlight the diagnostic significance of specific retinal hemorrhage patterns in infants.
- To emphasize the role of ophthalmologists in diagnosing AHT.
- To differentiate AHT-related RH from other causes in infants.
Main Methods:
- Review of clinical presentations and diagnostic criteria for abusive head trauma in infants.
- Analysis of retinal hemorrhage patterns, including extent, layering, and peripheral involvement.
- Correlation of retinal findings with brain injury and exclusion of alternative etiologies.
Main Results:
- Bilateral, extensive, multilayered RH extending to the periphery in infants under 3 years, alongside brain injury, strongly suggests AHT.
- Specific retinal findings like retinoschisis are highly suggestive of AHT.
- The diagnosis of AHT should be considered when other causes like leukemia or trauma are absent.
Conclusions:
- Ophthalmologists play a critical role in identifying and reporting AHT through detailed retinal examination.
- Pattern recognition of retinal hemorrhages is crucial for diagnosing AHT in infants.
- Effective communication between ophthalmologists, pediatricians, and child protection teams is vital for timely diagnosis and intervention.
Abstract:
Brain injuries due to abusive head trauma (AHT) in infants are not rare and they are probably under-diagnosed. Retinal hemorrhages (RH) constitute a cardinal symptom of AHT and AHT is the most common cause of RH in infants next to childbirth. Retinoschisis with or without retinal folds is highly suggestive of AHT and never seen secondary to childbirth. Bilateral extensive RH that are too numerous to count, multilayered and extending to the peripheral retina in infants < 3 years of age, in combination with brain injury and in absence of leukemia, ruptured brain aneurysm/AVM, fatal head crush or known severe accidental trauma must be considered to be caused by AHT in the absence of any other compelling factors. The ophthalmologist has an important role and a responsibility in describing the pattern of RH and in evaluating the likelihood of the diagnosis in the medical report and in communication with pediatricians and child protection team.
