title: Patterns of retinal hemorrhage associated with pediatric cerebral sinovenous thrombosis.
abstract: Cerebral sinovenous thrombosis (CSVT) has been proposed as an alternative cause of retinal hemorrhage (RH) in children being evaluated for abusive head trauma. This study investigated the prevalence and characteristics of RH in children with CSVT.
  
  
  
  The medical records of children >6 weeks of age with newly diagnosed CSVT and fundus examination by an ophthalmologist were examined retrospectively. Primary outcomes were presence and patterns of RH.
  
  
  
  A total of 29 children (median age, 9 years; range, 7 weeks to 17 years) were studied. Of these, 5 (17%) had RH, in 4 of whom RH were peripapillary, superficial, intraretinal, and adjacent to a swollen optic disk. In the fifth child, who had meningitis, sepsis, and multiple cerebral infarcts, there were a moderate number of posterior pole intraretinal hemorrhages. Eighteen children (62%) had optic disk swelling. In 13 children, cerebrospinal fluid opening pressure was recorded (range, 27-59 cm H2O). CSVT risk factors included meningitis, mastoiditis, and hypercoagulability.
  
  
  
  RH in pediatric CSVT was uncommon. When RHs were present, the appearance matched RH patterns known to be caused by medical conditions, such as raised intracranial pressure and sepsis, also present in these children. These findings suggest that the RHs are due to these other causes and not directly to CSVT itself. In children with CSVT, if RHs are multilayered, extend beyond the peripapillary region into the rest of the posterior pole or retinal periphery, or occur in the absence of optic disk swelling, another etiology for the RH should be sought.
authors.affiliation: Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: binenbaum@email.chop.edu.
authors.forename: Gil
authors.initials: G
authors.lastname: Binenbaum
authors.affiliation: Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Reid
authors.affiliation: Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: David L
authors.initials: DL
authors.lastname: Rogers
authors.affiliation: Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Jensen
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Billinghurst
authors.affiliation: Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Forbes
mesh_terms: D000293:Adolescent; D015170:Cerebrospinal Fluid Pressure; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008297:Male; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology; D015995:Prevalence; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed