APR 07, 2014
This study found that during inflicted head injury in children younger than age 3, a type of trauma occurs causing additional hypoxic-ischemic brain injury (HII) and severe retinal hemorrhages but not necessarily causing more severe traumatic intracranial injuries.
They also found that HII is not a necessary factor for severe retinal hemorrhage to develop from inflicted trauma, as some children had severe retinal hemorrhages without HII.
The study included a consecutive cohort of 45 children younger than age 3 admitted to a single center with inflicted or accidental head trauma who underwent eye examinations and brain diffusion-weighted magnetic resonance imaging within one week of injury. Their images were analyzed by two independent masked examiners. Retinal hemorrhage was graded retrospectively on a scale from 1 (none) to 5 (severe).
Retinal hemorrhage score was 3 to 5 in six of the seven patients with predominantly post-traumatic HII pattern and in four of the 32 patients who had traumatic injury without HII (P < 0.001). Severe retinal hemorrhage was observed in the absence of HII but only in inflicted injury. Retinal hemorrhage severity was correlated with HII severity (P < 0.001) but not with traumatic injury severity (P = 0.50). HII severity was associated with retinal hemorrhage score 3 to 5 (P = 0.01), but traumatic injury severity was not (P = 0.37).
Retinal hemorrhage severity did not correlate with radiologically defined traumatic intracranial injury severity even though traumatic injury lesions were present in all cases with a predominantly post-traumatic HII pattern.
The study’s results raise the possibility that the mechanisms responsible for HII may play a role in the pathogenesis of retinal hemorrhage in the setting of trauma.