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Published on: September 11, 2013
Retinal hemorrhages in children with traumatic intracranial pathology in a tertiary care center
Rachelle Srinivas1, Kolapo Dairo2, Catherine O Jordan3
1Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan.
Insights
Abusive head trauma (AHT) is frequently associated with retinal hemorrhages (RH) in children under five. This study found RH and intracranial pathology were more common in AHT cases than accidental trauma, supporting AHT in the differential diagnosis for pediatric RH.
Area of Science:
- Pediatric Ophthalmology
- Neurology
- Forensic Pathology
Background:
- Retinal hemorrhages (RH) are a common finding in pediatric abusive head trauma (AHT).
- The correlation between the etiology of presentation and the presence/pattern of RH and intracranial pathology requires further investigation.
Purpose of the Study:
- To evaluate pediatric patients who underwent neuroimaging and ophthalmologic examination.
- To correlate the cause of injury with the presence and pattern of RH and intracranial pathology.
Main Methods:
- Retrospective review of hospitalized patients under 5 years old.
- Recorded presence of intracranial pathology, RH, and diagnoses (AHT vs. accidental trauma).
- Evaluated fundus photographs using a published scale for RH grading.
Main Results:
- 65% of AHT patients had RH, with 57% graded as 2Bii or worse.
- None of the accidental trauma patients had RH, though 76% had acute intracranial hemorrhage (ICH).
- AHT patients showed a significantly higher occurrence of acute ICH with RH compared to accidental trauma patients.
Conclusions:
- The majority of RH in children under 5 with trauma were observed in AHT cases.
- Intracranial pathology alone does not typically cause RH.
- RH in young children with trauma warrants consideration of AHT in the differential diagnosis.
Background:
Retinal hemorrhages (RH) are commonly seen with abusive head trauma (AHT). This study evaluates pediatric patients who had neuroimaging and an ophthalmologic examination in an attempt to correlate the etiology of presentation with the presence and pattern of RH and intracranial pathology.
Methods:
A retrospective review was performed on hospitalized patients under 5 years of age who underwent neuroimaging and ocular examination. The presence of intracranial pathology, RH, and diagnoses of AHT versus accidental trauma were recorded. Fundus photographs were evaluated with a published scale for RH grading.
Results:
Seventy-six patients were categorized as AHT, 79% of whom had acute intracranial hemorrhage (ICH). Fifty-eight percent had RH with acute ICH. Thirty-three patients were categorized as accidental trauma. None of the accidental trauma patients had RH, but 76% had acute ICH. Sixty-five percent of AHT patients had RH, with 57% of these categorized as grade 2Bii or worse. There was a significant difference when comparing the occurrence of acute ICH with RH among AHT patients (n = 44) versus accidental trauma patients (n = 0/33 [P < 0.001]). There were more accidental trauma patients with acute ICH and without RH (n = 25/33) versus AHT patients with acute ICH and without RH (n = 16/76 [P < 0.001]).
Conclusions:
Among children who underwent both neuroimaging and eye examination, the majority of RH were in AHT patients. In all groups, there were numerous cases of intracranial pathology without RH, suggesting that intracranial pathology alone does not typically cause RH. Using a published scale for RH grade, our results support including AHT in the differential diagnosis when RH are seen in children under 5 years of age with signs of trauma.
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