Retinal haemorrhages and convulsions

Abstract

Aims-To evaluate the incidence of retinal haemorrhages after convulsions in children. Patients and methods-All children who required hospital admission after an episode of convulsions were included in the study. Complete neurological and ocular examinations, including ophthalmoscopy, were undertaken within 48 hours of hospital admission. Results-Thirty three children were examined according to the protocol and their seizures were classified by a paediatric neurologist. Despite the fact that some of the children also vomited or underwent cardiopulmonary resuscitation, none of the 33 children developed retinal haemorrhages. Conclusions-Convulsions rarely (if ever)give rise to retinal haemorrhages. The finding of retinal haemorrhages should stimulate a detailed assessment to exclude non-accidental injury, whatever the nature of the associated or antecedent events.

Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury

“…Accordingly, a further, more comprehensive study in 153 children aged 2 months to 2 years, who were examined by an ophthalmologist following an epileptic seizure revealed only one 8-month-old girl with unilateral flameshaped RH around the optic disk [80]. In a recent study of 32 children requiring hospitalization after a seizure (mean age, 30 months), none had RH, although some of the children were resuscitated [104]. No RHs were found in 100 infants with vomiting caused by hypertrophic pyloric stenosis [56].…”

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

“…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].…”

Retinal hemorrhage and pediatric brain injury: etiology and review of the literature

“…Thus, retinal hemorrhage is not the only ocular sign of child abuse. 6,10,11 With regard to appearance, the hemorrhages of child abuse are usually intraretinal; deep intraretinal hemorrhages having a "dot" and "blot" pattern, superficial hemorrhages taking on a "splinter" and "flame" pattern. Often, all of the retinal layers are involved in the hemorrhages.…”