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Unrecognized microscopic hyphema masquerading as a closed head injury

D K Coats1, E A Paysse, J Kong

  • 1Cullen Eye Institute, Baylor College of Medicine, Texas Children's Hospital, Houston 77030, USA.

Pediatrics
|September 17, 1998
PubMed

Insights

A child’s neurological symptoms were misdiagnosed as a head injury due to an unrecognized microscopic hyphema and acute glaucoma. Prompt ophthalmologic exams are crucial for children with trauma history to prevent misdiagnosis of ocular conditions.

Area of Science:

  • Ophthalmology
  • Pediatric Neurology
  • Emergency Medicine

Background:

  • Pediatric head injuries can present with non-specific neurological symptoms.
  • Ocular trauma is a potential cause of such symptoms, sometimes overlooked.
  • Sickle cell trait can be associated with ocular complications.

Observation:

  • A child with sickle cell trait presented with symptoms mimicking a closed head injury.
  • Initial evaluation included head CT and lumbar puncture, consistent with head trauma management.
  • Ophthalmologic consultation revealed microscopic hyphema and acute glaucoma.

Findings:

  • The child's neurological signs and symptoms were directly caused by occult ocular injury.
  • Microscopic hyphema and acute glaucoma were the underlying conditions.
  • The ocular injury was initially unrecognized, leading to misdiagnosis.

Implications:

  • Children with neurological symptoms and a history of trauma require prompt ophthalmologic evaluation.
  • Undetected hyphema can lead to acute glaucoma, mimicking head injury.
  • Early diagnosis of ocular conditions is vital to prevent misdiagnosis and ensure appropriate treatment.
Abstract

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