Unilaterale Netzhautblutungen bei Säuglingen – 2 Fälle von Schütteltrauma?

Abstract

ZusammenfassungEin 2,5 Monate alter Junge und ein 2 Monate altes Mädchen wurden wegen schwerer Bewusstseinstrübung pädiatrisch behandelt. Bei beiden Kindern fanden sich Subduralhämatome. Bei Verdacht auf nichtakzidentelles Schädel-Hirn-Trauma (NAHI) erfolgte eine Untersuchung des Augenhintergrundes, bei der sich bei beiden Säuglingen unilaterale Netzhautblutungen zeigten. Nach intensiver Differenzialdiagnostik wurde in beiden Fällen der Verdacht auf ein NAHI gestellt und eine rechtsmedizinische Begutachtung initiiert. Wichtig an dieser Fallserie ist, dass die Einseitigkeit von Netzhautblutungen ein NAHI nicht ausschließt.

New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review

“…Even Barth et al [87] highlight in their case report the possibility of unilateral retinal hemorrhages in victims of AHT, especially if the traumatic insult is located on a specific side. Notably, both reported cases were under 3 months of age, supporting the hypothesis that an age of >6 months is a predisposing factor for the onset of ocular injuries.…”

“…Subsequently, 123 articles were excluded because they did not meet the inclusion criteria. Finally, 16 articles were included for qualitative analysis [71,78,[87][88][89][90][91][92][93][94][95][96][97][98][99][100] (Figure 1).…”

“…The 16 included studies were performed in eight countries (Canada, The U.S.A., The Netherlands, France, Germany, Italy, Japan, and Thailand) across three continents between 2016 and 2021. Despite two articles [87,88] being written in German, all of the considered papers presented abstracts written in English. From a structural point of view, six of them consist of case reports or case series associated with a brief literature review [71,87,88,[91][92][93]; two articles consist of reviews of the scientific knowledge available at the time of writing [78,98]; one is a technical note of the author [90]; and the seven remaining are original articles, all statistically validated [89,[94][95][96][97]99,100].…”

“…Except for the review articles, the remaining works account for a complete cohort of 296 infant victims of AHT within the age range from 10 days (0 months) to 1041 days (34.7 months). Different methodologies were pursued among the considered works; clinical examination of alive subjects was executed by means of ophthalmoscopy or a combination of RETcam and OCT [87,88,90,92,97,99]; imaging techniques were employed by means of Magnetic Resonance Imaging (MRI) with different time-weights (3D-SWI, coronal T2-w, T1-w, and axial GRE T2-w protocols) [78,96]; forensic autopsies permitted the direct observation of macroscopic pathologic alterations of the eye and periorbital soft tissues [71,88,98]; and histopathological investigations were based on traditional H&E staining [71,88,91,94,95,98,100], histochemical iron-specific and PAS stains [91,94,95,100], and immunohistochemical reactants (β-APP, ubiquitin, GFAP, Glycophorin A, Nestin, CD44, and collagen type IX) [89,98,100]. The main characteristics of the selected articles are summarized in Table 3.…”

Immer noch Raum für Disput: zum STS und AHT (Abusive Head Trauma)

“…Fehlende Netzhautblutungen schließen ein STS, wie mitgeteilt, nicht aus. Einseitigkeit der Blutungen ist durchaus mit einem STS vereinbar 11 , 18 , 19 , wobei die Netzhautblutungen i. d. R. auf der gleichen Seite liegen wie die assoziierte intrakranielle Blutung 11 , 19 . Für die Unilateralität der Blutungen gibt es eine nicht bewiesene, aber plausible, biomechanische Erklärung 19 , 20 .…”