Retinal haemorrhage in abusive head trauma

Abstract

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.

Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma

“…Similar to prior research, bruising was an associated risk of AHT in our study cohort (Morad et al, 2010). While there were significantly higher rates of skeletal injuries in AHT patients (e.g., posterior rib fractures, metaphyseal fractures), these injuries were not risks associated with AHT in our study cohort.…”

Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma

“…Similar to prior research, bruising was an associated risk of AHT in our study cohort (Morad et al, 2010). While there were significantly higher rates of skeletal injuries in AHT patients (e.g., posterior rib fractures, metaphyseal fractures), these injuries were not risks associated with AHT in our study cohort.…”

Infantile Acute Subdural Hematoma with Retinal Hemorrhage Caused by Minor Occipital Impact Witnessed by an ICU Nurse: A Case Report

“…Although multilayered retinal hemorrhages are considered to be highly suggestive of child abuse [11], the present case confirmed that retinal hemorrhages identical to those observed in the victims of child abuse are also associated with i-ASDH.…”

Spatiotemporal Mapping of Biomechanical Stress Predicts Region-Specific Retinal Injury in a Murine Model of Blunt Ocular Trauma

“…Our data on the equatorial region, where moderate tensile stress from zonular traction corresponded with retinoschisis, underscores a second injury pathway. This mirrors clinical observations in abusive head trauma, where vitreoretinal traction during acceleration–deceleration forces leads to characteristic peripheral retinal hemorrhages and retinoschisis [ 30 ]. The splitting of retinal layers (retinoschisis) is a recognized precursor to full-thickness retinal detachment.…”

Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma

“…Similar to prior research, bruising was an associated risk of AHT in our study cohort (Morad et al, 2010). While there were significantly higher rates of skeletal injuries in AHT patients (e.g., posterior rib fractures, metaphyseal fractures), these injuries were not risks associated with AHT in our study cohort.…”

Infantile Acute Subdural Hematoma with Retinal Hemorrhage Caused by Minor Occipital Impact Witnessed by an ICU Nurse: A Case Report

“…Although multilayered retinal hemorrhages are considered to be highly suggestive of child abuse [11], the present case confirmed that retinal hemorrhages identical to those observed in the victims of child abuse are also associated with i-ASDH.…”

Spatiotemporal Mapping of Biomechanical Stress Predicts Region-Specific Retinal Injury in a Murine Model of Blunt Ocular Trauma

“…Our data on the equatorial region, where moderate tensile stress from zonular traction corresponded with retinoschisis, underscores a second injury pathway. This mirrors clinical observations in abusive head trauma, where vitreoretinal traction during acceleration–deceleration forces leads to characteristic peripheral retinal hemorrhages and retinoschisis [ 30 ]. The splitting of retinal layers (retinoschisis) is a recognized precursor to full-thickness retinal detachment.…”

Intimate Partner Violence, Clinical Indications, and Other Family Risk Factors Associated With Pediatric Abusive Head Trauma

“…Similar to prior research, bruising was an associated risk of AHT in our study cohort (Morad et al, 2010). While there were significantly higher rates of skeletal injuries in AHT patients (e.g., posterior rib fractures, metaphyseal fractures), these injuries were not risks associated with AHT in our study cohort.…”

Infantile Acute Subdural Hematoma with Retinal Hemorrhage Caused by Minor Occipital Impact Witnessed by an ICU Nurse: A Case Report

“…Although multilayered retinal hemorrhages are considered to be highly suggestive of child abuse [11], the present case confirmed that retinal hemorrhages identical to those observed in the victims of child abuse are also associated with i-ASDH.…”

Spatiotemporal Mapping of Biomechanical Stress Predicts Region-Specific Retinal Injury in a Murine Model of Blunt Ocular Trauma

“…Our data on the equatorial region, where moderate tensile stress from zonular traction corresponded with retinoschisis, underscores a second injury pathway. This mirrors clinical observations in abusive head trauma, where vitreoretinal traction during acceleration–deceleration forces leads to characteristic peripheral retinal hemorrhages and retinoschisis [ 30 ]. The splitting of retinal layers (retinoschisis) is a recognized precursor to full-thickness retinal detachment.…”