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Neuroradiological features amongst children with retinal haemorrhages

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


  • Amongst comparative studies, where the detail is available, all cases had abnormalities on neuroimaging 1,3,4,8,11,12,14-17 apart from in one study 2 where all AHT had abnormailites but 2/16 nAHT did not
  • Of note amongst nAHT cases, two studies 5,13 noted retinal haemorrhages  in conjunction with some children with extradural haemorrhages, although in one case these were only noted post-surgery 5 , the remaining cases underwent surgery but it is unclear as to whether the retinal examination was conducted pre or post-operatively 13
  • Nine cases 6,7,9,17 had neurological symptoms but no identifiable abnormalities on initial imaging. However, subsequent imaging in 3/9 cases became abnormal, five did not undergo repeat imaging, and one with severe neurological symptoms had normal imaging repeated on three occasions

  • There appears to be a correlation between severity of retinal haemorrhage and hypoxic ischaemic injury 2,8

Please note that the six cases fromare the same as those in the included study by the same author10 (as confirmed by author correspondence) but described in more detail

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  1. Bechtel K, Stoessel K, Leventhal JM, Ogle E, Teague B, Lavietes S, Banyas B, Allen K, Dziura J, Duncan C. Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. Pediatrics. 2004;114(1):165-168 [Pubmed]
  2. Binenbaum G, Christian CW, Ichord RN, Ying GS, Simon MA, Romero K, Pollock AN, Forbes BJ. Retinal hemorrhage and brain injury patterns on diffusion-weighted magnetic resonance imaging in children with head trauma. Journal of AAPOS. 2013;17(6):603-8 [Pubmed]

  3. Buys YM, Levin AV, Enzenauer RW, Elder JE, Letourneau MA, Humphreys RP, Mian M, Morin JD. Retinal findings after head trauma in infants and young children. Ophthalmology. 1992;99(11):1718-1723 [Pubmed]
  4. Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics. 2001;108(3):636-646 [Pubmed]
  5. Forbes BJ, Cox M, Christian CW. Retinal hemorrhages in patients with epidural hematomas. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2008;12(2):177-180 [Pubmed]
  6. Giangiacomo J, Barkett KJ. Ophthalmoscopic findings in occult child abuse. Journal of Pediatric Ophthalmology and Strabismus. 1985;22(6):234-237 [Pubmed]
  7. Healey K, Schrading W. A case of shaken baby syndrome with unilateral retinal hemorrhage with no associated intracranial hemorrhage. American Journal of Emergency Medicine. 2006;24(5):616-617 [Pubmed citation only]
  8. Minns RA, Jones PA, Tandon A, Fleck BW, Mulvihill AO, Elton RA. Prediction of inflicted brain injury in infants and children using retinal imaging. Pediatrics. 2012;130(5):e1227-34 [Pubmed]

  9. Morad Y, Avni I, Benton SA, Berger RP, Byerley JS, Coffman K, Greeley CS, Gustavson EE, Levitt CJ, Lenane A, Topley J, Levin AV. Normal computerized tomography of brain in children with shaken baby syndrome. Journal of AAPOS: American Association for Pediatric Ophthalmology and Strabismus. 2004;8(5):445-450 [Pubmed]
  10. Morad Y, Kim YM, Armstrong DC, Huyer D, Mian M, Levin AV. Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome. American Journal of Ophthalmology. 2002;134(3):354-359 [Pubmed]
  11. Pierre-Kahn V, Roche O, Dureau P, Uteza Y, Renier D, Pierre-Kahn A, Dufier JL. Ophthalmologic findings in suspected child abuse victims with subdural hematomas. Ophthalmology. 2003;110(9):1718-1723 [Pubmed]
  12. Sturm V, Knecht PB, Landau K, Menke MN. Rare retinal haemorrhages in translational accidental head trauma in children. Eye. 2009;23(7):1535-41 [Pubmed]

  13. Trenchs V, Curcoy AI, Morales M, Serra A, Navarro R, Pou J. Retinal haemorrhages in head trauma resulting from falls: differential diagnosis with non-accidental trauma in patients younger than 2 years of age. Child's Nervous System. 2008;24(7):815-820 [Pubmed]
  14. Trenchs V, Curcoy AI, Navarro R, Pou J. Subdural haematomas and physical abuse in the first two years of life. Pediatric Neurosurgery. 2007;43(5):352-357 [Pubmed]
  15. Vinchon M, Defoort-Dhellemmes S, Desurmont M, Dhellemmes P. Accidental and nonaccidental head injuries in infants: a prospective study. Journal of Neurosurgery. 2005;102(4 Suppl):380-384 [Pubmed]
  16. Vinchon M, Defoort-Dhellemmes S, Noulé N, Duhem R, Dhellemmes P. Accidental or non-accidental brain injury in infants. Prospective study of 88 cases [French]. Presse Médicale. 2004;33(17):1174-1179 [Pubmed]
  17. Wahl NG, Woodall BN. Hypothermia in shaken infant syndrome. Pediatric Emergency Care. 1995;11(4):233-234 [Pubmed citation only]


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