Diffuse unilateral hemorrhagic retinopathy associated with accidental perinatal strangulation. A clinicopathologic report.
OBJECTIVE
To report an unusual case of diffuse retinal hemorrhage associated with strangulation in a neonate with a tightly wrapped nuchal cord around his neck at birth who was noted to have eyelid and subconjunctival petechial hemorrhages upon delivery.


METHODS
Clinical diagnostic examination as well as postmortem gross and histopathologic examination of ocular and central nervous system structures was performed.


RESULTS
Funduscopic and gross pathologic examination of the eyes revealed extensive unilateral retinal hemorrhage of the right eye only. This was corroborated by histopathologic studies, which revealed unilateral diffuse hemorrhage throughout all nuclear layers of the retina with a particularly dense nerve fiber layer and sub-internal limiting membrane hemorrhage in the macula along with extraocular muscle and episcleral hemorrhage. Clinical, gross, and microscopic examination also revealed multiple areas of hemorrhage involving the right side of the brain and throughout the cerebellum.


CONCLUSIONS
Although retinal findings in nonaccidental trauma are common, accidental strangulation retinopathy in neonates is a rare occurrence. To the authors' knowledge, this case is the only documented histopathologic study of hemorrhagic retinopathy associated with strangulation in the literature.
Shaikh
S
S
Associated Retinal Consultants and William Beaumont Hospital, Royal Oak, Michigan, USA.
Fishman
M L
ML
Gaynon
M
M
Alcorn
D
D
D000402:Airway Obstruction / Q000150:complications / Q000473:pathology*; D001238:Asphyxia Neonatorum / Q000150:complications / Q000473:pathology*; D003229:Conjunctival Diseases / Q000209:etiology / Q000473:pathology; D005141:Eyelid Diseases / Q000209:etiology / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities; D008297:Male; D007690:Polycystic Kidney Diseases / Q000209:etiology / Q000473:pathology; D012166:Retinal Hemorrhage / Q000209:etiology / Q000473:pathology*