[Retinal hemorrhages in abusive head trauma]

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.