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[Vitreous hemorrhage after accidental head injury with chest compression--case report]
Insights
Vitreous hemorrhage is a rare complication of accidental head injury in infants. This case highlights how head trauma with chest compression can lead to severe intracranial and retinal bleeding.
Area of Science:
- Ophthalmology
- Pediatrics
- Neurology
Background:
- Vitreous hemorrhage is common after subarachnoid hemorrhage but rare after accidental head injury.
- Accidental head injuries in infants can lead to severe ocular and neurological complications.
Observation:
- A 4-month-old infant presented with altered consciousness and seizures after head trauma and chest compression.
- Computed tomography revealed subdural hematoma, and examination showed bilateral vitreous hemorrhage and elevated fontanelle pressure.
- Radiological findings were consistent with shaken baby syndrome.
Findings:
- The case suggests a link between abrupt deceleration, acute intrathoracic hypertension, and acute intracranial hypertension.
- These combined pressures likely caused retinal hemorrhage, potentially leading to vitreous hemorrhage.
- Conservative management improved the infant's consciousness and vision.
Implications:
- This case underscores the importance of considering vitreous hemorrhage in infants with head trauma and signs of increased intracranial pressure.
- Understanding the mechanism of injury, including chest compression, is crucial for diagnosis and management.
- Early recognition and treatment can lead to favorable outcomes in severe pediatric head injuries.
Abstract:
Vitreous hemorrhage is relatively common following subarachnoid hemorrhage, but rarely occurs after accidental head injury. In this paper, we report a rare case of vitreous hemorrhage after an accidental head injury with chest compression. A 4-month-old girl was held in her father's arms. After he fell down, she struck her head and her chest was compressed by her father's body. She soon became pale and was immediately transported to our center complaining of disturbance of consciousness on February 6, 1993. On admission, she was semicomatose and had a generalized convulsion. Computed tomography (CT) scan showed a subdural hematoma, although no fracture was detected on the plain X-ray film. Bilateral vitreous hemorrhage was also observed. The anterior fontanelle pressure was a high 330 mmH2O. The patient was treated conservatively with agents to promote hemostasis and reduce the intracranial hypertension. She was discharged after one month with normal consciousness and improved vision. The follow-up CT scan revealed subdural hematoma, hemorrhagic infarction (suggesting rupture of the pontine veins), and cerebral atrophy, corresponding to those of the shaken baby syndrome. Her chest was compressed by her father's body. The anterior fontanelle pressure was a high 330 mmH2O. These findings suggest that shaking or abrupt deceleration, acute intrathoracic hypertension and acute intracranial hypertension, caused retinal hemorrhage, and that extensive retinal hemorrhage possibly resulted in vitreous hemorrhage.