Retinal hemorrhage and bleeding disorders in children: A review

Thau, Avrey; Saffren, Brooke; Zakrzewski, Helena; Anderst, James D.; Carpenter, Shannon L.; Levin, Alex V.

doi:10.1016/j.chiabu.2020.104901

Cited by 12 publications

(6 citation statements)

References 155 publications

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“…Recognition by health professionals is hindered by the lack of external signs, making caregiver education and health provider training essential to prevent accidental abusive head trauma and shaken baby syndrome. Proactive mental health care emerges as the most effective strategy to diminish child abuse, given its long-term financial and medical repercussions for survivors [1].…”

Section: Abusive Head Trauma and Shaken Baby Syndromementioning

confidence: 99%

“…One potential cause of retinal hemorrhage is coagulopathy, which encompasses diverse pathologies that prevent timely clotting and cessation of bleeding. Still, according to a recently published systematic review, even the presence of an underlying coagulopathy cannot be considered a concrete reason to rule out the possibility of AHT, since certain pathologic findings including retinoschisis or retinal folds are mostly attributed to abusive trauma and not coagulopathies [1].…”

Section: Retinal Hemorrhage In Childrenmentioning

confidence: 99%

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An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse

Shahraki,

Suh

2024

Children

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Abusive head trauma (AHT) is an extreme form of physical child abuse, a subset of which is shaken baby syndrome (SBS). While traumatic injury in children is most readily observed as marks of contusion on the body, AHT/SBS may result in internal injuries that can put the life of the child in danger. One pivotal sign associated with AHT/SBS that cannot be spotted with the naked eye is retinal injury (RI), an early sign of which is retinal hemorrhage (RH) in cases with rupture of the retinal vasculature. If not addressed, RI can lead to irreversible outcomes, such as visual loss. It is widely assumed that the major cause of RI is acceleration–deceleration forces that are repeatedly imposed on the patient during abusive shaking. Still, due to the controversial nature of this type of injury, few investigations have ever sought to delve into its biomechanical and/or biochemical features using realistic models. As such, our knowledge regarding AHT-/SBS-induced RI is significantly lacking. In this mini-review, we aim to provide an up-to-date account of the traumatology of AHT-/SBS-induced RI, as well as its biomechanical and biochemical features, while focusing on some of the experimental models that have been developed in recent years for studying retinal hemorrhage in the context of AHT/SBS.

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Section: Abusive Head Trauma and Shaken Baby Syndromementioning

confidence: 99%

Section: Retinal Hemorrhage In Childrenmentioning

confidence: 99%

An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse

Shahraki,

Suh

2024

Children

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“…Retinal hemorrhages can pose substantial diagnostic challenges due to their association with various systemic and ocular diseases [1]. The retina comprises a total of 10 layers, with the outermost layer being the retinal pigmented epithelium (RPE), followed by 9 other 2 of 11 layers collectively known as the neurosensory retina.…”

Section: Introductionmentioning

confidence: 99%

“…The differential diagnosis of retinal hemorrhages is extensive and includes [3,5] coagulopathy, blood dyscrasia, severe anemia, hemolytic uremic syndrome, endocarditis, vasculitis [2,3], normal birth [6], raised intracranial pressure (ICP), glutaric aciduria type 1, meningitis and Terson syndrome [7]. Retinal hemorrhages can also be diagnostic indicators for severe conditions such as abusive head trauma [1,2,[8][9][10][11]. Common causes of retinal hemorrhage in adults include diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion [2,3,12], trauma [9,13], and hematological disorders [2].…”

Section: Introductionmentioning

confidence: 99%

Deep Learning Approach for Differentiating Etiologies of Pediatric Retinal Hemorrhages: A Multicenter Study

Khosravi,

Huck,

Shahraki

et al. 2023

IJMS

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Retinal hemorrhages in pediatric patients can be a diagnostic challenge for ophthalmologists. These hemorrhages can occur due to various underlying etiologies, including abusive head trauma, accidental trauma, and medical conditions. Accurate identification of the etiology is crucial for appropriate management and legal considerations. In recent years, deep learning techniques have shown promise in assisting healthcare professionals in making more accurate and timely diagnosis of a variety of disorders. We explore the potential of deep learning approaches for differentiating etiologies of pediatric retinal hemorrhages. Our study, which spanned multiple centers, analyzed 898 images, resulting in a final dataset of 597 retinal hemorrhage fundus photos categorized into medical (49.9%) and trauma (50.1%) etiologies. Deep learning models, specifically those based on ResNet and transformer architectures, were applied; FastViT-SA12, a hybrid transformer model, achieved the highest accuracy (90.55%) and area under the receiver operating characteristic curve (AUC) of 90.55%, while ResNet18 secured the highest sensitivity value (96.77%) on an independent test dataset. The study highlighted areas for optimization in artificial intelligence (AI) models specifically for pediatric retinal hemorrhages. While AI proves valuable in diagnosing these hemorrhages, the expertise of medical professionals remains irreplaceable. Collaborative efforts between AI specialists and pediatric ophthalmologists are crucial to fully harness AI’s potential in diagnosing etiologies of pediatric retinal hemorrhages.

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“…Величина геморрагий может быть различна, от незначительных до больших, достигающих нескольких диаметров диска зрительного нерва (ДЗН) [1]. Чаще всего в офтальмологической практике преретинальные геморрагии встречаются при ретинопатии Вальсальвы [2], синдроме Терсона [3], гематологических нарушениях [4], макроаневризмах сетчатки [5] или травмах [6].…”

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Preretinal Hemorrhage Caused by Valsalva Retinopathy and Terson Syndrome

Dulchenko,

Stanishevskaya

2024

СПНО (MPSE)

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Preretinal hemorrhage as a cause of sudden vision loss is not often encountered in the clinical practice of an ophthalmologist. Diseases leading to preretinal hemorrhage include Valsalva retinopathy, Terson syndrome, hematologic disorders, trauma, and retinal macroaneurysms. Valsalva retinopathy is a specific type of retinopathy that occurs in somatically healthy people against the background of a sharp increase in intrathoracic or intra-abdominal pressure. Terson syndrome occurs with subarachnoid hemorrhages or intracerebral hemorrhages as a result of increased intracranial pressure. These pathologies are characterized by sudden unilateral, less often bilateral, loss of vision. Purpose: to present clinical cases of patients with preretinal hemorrhage caused by Valsalva retinopathy and Terson syndrome. Material and methods: clinical cases of three patients with preretinal hemorrhage caused by Valsalva retinopathy and Terson syndrome are presented. The patients were observed and treated at the S.Fyodorov Eye Microsurgery Federal State Institution, Novosibirsk Branch. Result and discussions: clinical cases demonstrate the development of preretinal hemorrhage after a sharp cough and sneezing, as well as after suffering a parenchymal-ventricular hemorrhage. All patients underwent Nd:YAG laser hyaloid puncture early after diagnosis with high functional results. Conclusion: in the presence of preretinal hemorrhage, to make a diagnosis of Valsalva retinopathy or Terson syndrome, special attention should be paid to obtaining an anamnesis to identify conditions associated with increased intrathoracic or intra-abdominal pressure, or possible subarachnoid, intracerebral hemorrhage in the past. The size and duration of hemorrhage are the most important factors in determining treatment options. Timely implementation of laser hyaloid puncture in the treatment of extensive preretinal hemorrhages is an effective and safe method of treatment, which allows one to obtain high functional results in the shortest possible time.

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Retinal hemorrhage and bleeding disorders in children: A review

Cited by 12 publications

References 155 publications

An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse

An Update to Biomechanical and Biochemical Principles of Retinal Injury in Child Abuse

Deep Learning Approach for Differentiating Etiologies of Pediatric Retinal Hemorrhages: A Multicenter Study

Preretinal Hemorrhage Caused by Valsalva Retinopathy and Terson Syndrome

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