Retinale Blutungen und venöse Stase bei einem 10 Monate alten Säugling nach Sturz?

Abstract

This report describes the case of a 10-month-old infant, who was delivered to our hospital by the emergency physician intubated and in an unclear unconscious state. The father reported that the child had fallen from the couch to the ground. The consulted ophthalmologist reported venous stasis in both eyes including intraretinal and preretinal bleeding in all four quadrants, a diffuse vitreous hemorrhage in the right eye and temporal retinal wrinkling in both eyes. Based on these particular clinical findings a shaken baby syndrome was suspected. This report demonstrates the importance of recognizing and correctly interpreting the typical ophthalmological signs of physical child abuse in order to detect and prevent further mistreatment of children; moreover, the increasing importance of photographic documentation and histological work-up of the findings for forensic reasons are emphasized.

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

“…Finally, the team of Moskwa et al [97], in agreement with Fieß et al [88], emphasized the vast heterogeneity of ophthalmoscopic reports due to the high observer dependence, the high error rate when applied by non-specialists, and the poor sensitivity in detecting peri-equatorial lesions. Ultimately, when possible, they recommend the combined execution of further examinations, including visual field examinations and Optical Computed Tomography (OCT).…”

“…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.…”

“…At the end of a thorough anamnestic and instrumental evaluation, autopsy remains a fundamental tool for dealing with fatal cases of abusive head trauma (AHT) [88]. Specifically, the search for ophthalmological findings requires the execution of a specific sectorial protocol at the cranial level [71].…”