Do retinal haemorrhages occur in infants with convulsions?

Curcoy, Ana Isabel; Trenchs, Victoria; Morales, Marta; Serra, Alicia; Pineda, Merçè; Pou, Jordi

doi:10.1136/adc.2007.132522

Cited by 19 publications

(11 citation statements)

References 21 publications

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“…Resuscitation-related retinal hemorrhages are few in number and confined to the posterior pole [26]. Retinal hemorrhages following seizures are extremely rare, with an incidence across four studies of less than 0.1%, in which only one case had unilateral flame-shaped superficial retinal hemorrhages located just at the optic disc and nowhere else [29][30][31][32]. While valsalva retinopathy characterized by preretinal or vitreous hemorrhage (not intraretinal retinal hemorrhage) is a well-described entity in adults, excessive coughing has not been found to cause retinal hemorrhage in young children [33].…”

Section: Differential Diagnosismentioning

confidence: 97%

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

Binenbaum

Forbes

2014

Pediatr Radiol

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This review presents an up-to-date overview of ocular injuries resulting from child abuse, with a spotlight on abusive head trauma. Retinal hemorrhage is a principle finding of inflicted head trauma. The specific pattern of hemorrhages holds valuable diagnostic information, which can help to guide multidisciplinary assessments of the likelihood of abuse. Indirect ophthalmoscopy through dilated pupils by an ophthalmologist is necessary for adequate examination and documentation of retinal findings. Initial pediatrician evaluation of the eye and indications for ophthalmological consultation are reviewed. Focus is then placed upon understanding retinal hemorrhage patterns, their diagnostic significance and likely pathophysiological mechanisms. The differential diagnosis of retinal hemorrhage in young children is discussed, highlighting key distinctions among retinal hemorrhage patterns, severity and frequencies, as well as other ocular findings. The most common cause of retinal hemorrhage in an infant is trauma, and most other causes can be identified by considering the hemorrhage pattern, ocular or systemic signs and the results of laboratory and imaging tests, when indicated.

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Section: Differential Diagnosismentioning

confidence: 97%

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

Binenbaum

Forbes

2014

Pediatr Radiol

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“…10 Multiple conditions associated with increased intrathoracic pressure, such as seizures, cough, respiratory distress, or vomiting, are not associated with RH in children. [70][71][72][73][74][75][76] Other than a few hemorrhages in the posterior pole, RHs seem to be exceedingly rare after cardiopulmonary resuscitation with chest compressions, [77][78][79][80] including in a pig model. 81 Rare case reports that have suggested otherwise were complicated by multiple confounding systemic factors or poor evaluations to rule out abuse.…”

Section: Increased Intrathoracic Pressurementioning

confidence: 99%

Retinal Hemorrhage in Abusive Head Trauma

2010

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Retinal hemorrhage is a cardinal manifestation of abusive head trauma. Over the 30 years since the recognition of this association, multiple streams of research, including clinical, postmortem, animal, mechanical, and finite element studies, have created a robust understanding of the clinical features, diagnostic importance, differential diagnosis, and pathophysiology of this finding. The importance of describing the hemorrhages adequately is paramount in ensuring accurate and complete differential diagnosis. Challenges remain in developing models that adequately replicate the forces required to cause retinal hemorrhage in children. Although questions, such as the effect of increased intracranial pressure, hypoxia, and impact, are still raised (particularly in court), clinicians can confidently rely on a large and solid evidence base when assessing the implications of retinal hemorrhage in children with concern of possible child abuse.

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“…[6][7][8] In the literature, RHs have been suggested to occur in association with cardiopulmonary resuscitation (CPR), intracranial hemorrhages, raised intracranial pressure, bleeding diathesis (congenital or acquired), and seizures, 6,7 although the studies determining such an association have not revealed evidence to support all of these implicated etiologies with RH. [9][10][11][12][13][14][15][16][17][18] Furthermore, RHs in abuse have been observed commonly to be flame-shamed, bilateral, and multilayered, unlike RH seen in other postulated etiologies. 6 Because the majority of studies describing RH focus on patients with AHT, there is potential selection bias with a risk of circular reasoning.…”

mentioning

confidence: 99%