Retinal hemorrhage in child abuse [Neurosurgery Wiki]

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====== Retinal hemorrhage in child abuse ======

“In a traumatized child with multiple injuries and inconsistent history, the presence of [[retinal hemorrhage]] is pathognomonic of battering
((Meservy CJ, Towbin R, McLaurin RL, et al. Radiographic Characteristics of Skull Fractures Resulting from Child Abuse. AJR. 1987; 149:173–))

However, RH may also occur in the absence of any evidence of [[child abuse]]. 16/26 battered children<3 yrs of age had RH on funduscopy, whereas 1/32 non-battered traumatized children with head injury had RH (the single false positive: traumatic parturition, where the incidence of RH is 15–30%)
((Eisenbrey AB. Retinal Hemorrhage in the Battered Child. Childs Brain. 1979; 5:40–44))
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At least in [[Japan]]ese [[child]]ren, an [[infantile acute subdural hematoma]] was frequently observed not only in nonaccidental but also in accidental injuries. In infants with [[head trauma]], age, the presence of [[retinal hemorrhage]], and the presence of [[seizure]]s should be considered when determining whether they were abused. [[Subdural hematoma]] is also a powerful finding to detect abuse, but care should be taken because, in some ethnic groups, such as the [[Japan]]ese, there are many accidental cases
((Akutsu N, Nonaka M, Narisawa A, Kato M, Harada A, Park YS. Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group. PLoS One. 2022 Feb 25;17(2):e0264396. doi: 10.1371/journal.pone.0264396. PMID: 35213611.)).

===== Differential diagnosis =====

1. [[child abuse]] (including “[[shaken baby syndrome]]”)

2. [[benign subdural effusion]] in infants

3. acute high altitude sickness 

4. acute increase in ICP: e.g. with a severe seizure (may be similar to [[Purtscher’s retinopathy]])

5. [[Purtscher’s retinopathy]]
((Buckley SA, James B. Purtscher's retinopathy. Postgrad Med J. 1996; 72:409–412))