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Sequential cranial computed tomography in infants with retinal hemorrhages.
J Giangiacomo1, J A Khan, C Levine
1Department of Ophthalmology, University of Missouri-Columbia 65212.
Ophthalmology
|March 1, 1988
Summary
Retinal hemorrhages in infants can precede visible subdural hematomas on initial head computed tomography (CT) scans. Close monitoring is crucial, even with normal initial CT results, for early diagnosis of abusive head trauma.
Area of Science:
- Pediatric neurology
- Neuroradiology
- Ophthalmology
Background:
- Whiplash-shaken infant syndrome is a form of abusive head trauma.
- Early diagnosis is critical for patient outcomes.
Observation:
- Five infants with whiplash-shaken infant syndrome presented with lethargy, vomiting, irritability, and intraocular hemorrhage.
- Initial head computed tomography (CT) scans were normal or showed subtle abnormalities in three of the five infants.
- Retinal hemorrhages were observed in all five infants.
Findings:
- Subdural hematomas developed subsequently in three infants despite normal or subtle initial CT findings.
- Repeat CT scans revealed progressive ventricular dilation and bilateral fronto-parietal subdural hematomas.
- Intracerebral hemorrhages and cerebral edema were noted in the other two infants' initial CT scans, followed by subdural hematoma.
- Retinal hemorrhages consistently preceded the clinical and radiological diagnosis of subdural hematoma.
Implications:
- Unexplained retinal hemorrhages in infants warrant close observation, including head circumference monitoring, funduscopic examinations, and repeat head CT scans.
- These findings highlight the importance of considering abusive head trauma even when initial neuroimaging is non-diagnostic.
- Early and comprehensive evaluation is essential for timely intervention in suspected cases of infant abuse.