Angell Shi1, Abhaya Kulkarni2, Kenneth W Feldman3, Avery Weiss4, Emily A McCourt5, Susan Schloff6,7, Michael Partington8, Brian Forbes9, Brooke E Geddie10, Karin Bierbrauer11, Paul H Phillips12,13, David L Rogers14, Waleed Abed Alnabi15,16, Gil Binenbaum9, Alex V Levin17,15. 1. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. 2. Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada. 3. Departments of Pediatrics and. 4. Ophthalmology, Seattle Children's Hospital and School of Medicine, University of Washington, Seattle, Washington. 5. Department of Ophthalmology, Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado. 6. Associated Eye Care, St Paul, Minnesota. 7. Department of Ophthalmology and Visual Neurosciences, Children's Minnesota St Paul Hospital, St Paul, Minnesota. 8. Department of Neurosurgery, Gillette Children's Specialty Healthcare, St Paul, Minnesota. 9. Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 10. Division of Pediatric Ophthalmology, Helen DeVos Children's Hospital, Grand Rapids, Michigan. 11. Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 12. Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 13. Department of Ophthalmology, Arkansas Children's Hospital, Little Rock, Arkansas. 14. Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio. 15. Department of Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania; and. 16. Médecins Sans Frontieres, Amman, Jordan. 17. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; alevin@willseye.org.
Abstract
OBJECTIVES: Increased intracranial pressure (ICP) has been suggested in legal settings as an alternative cause of retinal hemorrhages (RHs) in young children who may have sustained abusive head trauma. We assessed the prevalence and characteristics of RHs in children with increased ICP. METHODS: We conducted a prospective, multicenter study of children <4 years old with newly diagnosed increased ICP as determined by using direct measurement and/or clinical criteria. Infants who were premature, neonates, and suspected survivors of abusive head trauma were excluded on the basis of nonocular findings. Fundus examinations were performed; extent, number, and type of RH in each of 4 distinct retinal zones were recorded. RESULTS: Fifty-six children (27 boys) were studied (mean age 15.4 months; range 1-43 months). All of the children had elevated ICP that required intervention. One child had papilledema. No child (0%; 95% confidence interval: 0%-6.4%) or eye (0%; 95% confidence interval: 0%-3.3%) was found to have an RH. Causes of increased ICP included hydrocephalus, intraventricular hemorrhage, congenital malformations, malfunctioning shunts, and the presence of intracranial space-occupying lesions. CONCLUSIONS: Although acute increased ICP can present in children with a pattern of peripapillary superficial RHs in the presence of papilledema, our study supports the conclusion that RHs rarely occur in the absence of optic disc swelling and do not present beyond the peripapillary area in the entities we have studied.
OBJECTIVES: Increased intracranial pressure (ICP) has been suggested in legal settings as an alternative cause of retinal hemorrhages (RHs) in young children who may have sustained abusive head trauma. We assessed the prevalence and characteristics of RHs in children with increased ICP. METHODS: We conducted a prospective, multicenter study of children <4 years old with newly diagnosed increased ICP as determined by using direct measurement and/or clinical criteria. Infants who were premature, neonates, and suspected survivors of abusive head trauma were excluded on the basis of nonocular findings. Fundus examinations were performed; extent, number, and type of RH in each of 4 distinct retinal zones were recorded. RESULTS: Fifty-six children (27 boys) were studied (mean age 15.4 months; range 1-43 months). All of the children had elevated ICP that required intervention. One child had papilledema. No child (0%; 95% confidence interval: 0%-6.4%) or eye (0%; 95% confidence interval: 0%-3.3%) was found to have an RH. Causes of increased ICP included hydrocephalus, intraventricular hemorrhage, congenital malformations, malfunctioning shunts, and the presence of intracranial space-occupying lesions. CONCLUSIONS: Although acute increased ICP can present in children with a pattern of peripapillary superficial RHs in the presence of papilledema, our study supports the conclusion that RHs rarely occur in the absence of optic disc swelling and do not present beyond the peripapillary area in the entities we have studied.
Authors: Heather T Keenan; Desmond K Runyan; Stephen W Marshall; Mary Alice Nocera; David F Merten Journal: Pediatrics Date: 2004-09 Impact factor: 7.124
Authors: Gil Binenbaum; David L Rogers; Brian J Forbes; Alex V Levin; Sireesha A Clark; Cindy W Christian; Grant T Liu; Robert Avery Journal: Pediatrics Date: 2013-07-22 Impact factor: 7.124