Retinal hemorrhage in child abuse
“In a traumatized child with multiple injuries and inconsistent history, the presence of retinal hemorrhage is pathognomonic of battering 1)
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%) 2)
At least in Japanese children, 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 seizures 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 Japanese, there are many accidental cases 3).
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)