Retinal hemorrhages in abusive head trauma with atraumatic neuroimaging

Abstract

We report 3 cases of suspected abusive head trauma with retinal hemorrhages on fundus examination and neuroimaging findings not necessarily suggestive of shaking injury. Previous studies have suggested that retinal hemorrhages are rare in patients without neuroimaging abnormalities. These cases demonstrate some common features (rib fractures, developmental delay, and history of abuse) that may increase suspicion for abusive head trauma. Our findings suggest a potential role for ophthalmic consultation in scenarios with high clinical suspicion for abusive head trauma without definitive neuroimaging evidence of head injury. The nonspecific neuroimaging features of these 3 cases highlight the importance of interpreting cases with global clinical context.

FIG 1.

RetCam3 fundus images of the right and left eyes of cases 1–3. A, Case 1, showing pre- and intraretinal hemorrhages in both eyes and retinoschisis in the left eye. B, Case 2, showing anomalous, hypoplastic optic nerves and mildly tortuous vessels in both eyes and multilayer hemorrhages in the left eye. C, Case 3, showing numerous intra- and preretinal hemorrhages in the right eye and intraretinal hemorrhages in the left eye.