Retinal haemorrhage in abusive head trauma.
Paediatric abusive head injury may have grave consequences, especially when characterized by repetitive acceleration-deceleration forces (shaken baby syndrome). Death occurs in approximately 30% and permanent neurologic damage in up to 80% of the victims. Retinal haemorrhages are a cardinal sign seen in approximately 85% of cases. In most cases haemorrhages are preretinal, intraretinal and subretinal, too numerous to count, and involving the entire retinal surface extending to the ora serrata. Traumatic macular retinoschisis is a lesion with important diagnostic significance. Vitreoretinal traction appears to be the mechanism of haemorrhage and schisis formation along with a possible role of orbital tissue trauma from repetitive acceleration-deceleration forces. Ophthalmologists must carefully document ocular findings. Appropriate autopsy examination should include ocular and orbital tissue removal. Although there is a wide differential diagnosis for retinal haemorrhages, clinical appearance, when considered in the context of systemic and laboratory findings, usually leads to the correct diagnosis.
Morad
Yair
Y
Pediatric Ophthalmology Service, Assaf Harofeh Medical Center, Zrifin.
Wygnansky-Jaffe
Tamara
T
Levin
Alex V
AV
D002649:Child Abuse; D006259:Craniocerebral Trauma / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D009885:Ophthalmology; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D038642:Shaken Baby Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology