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Retinal Findings in Young Children With Increased Intracranial Pressure From Nontraumatic Causes
Increased intracranial pressure (ICP) has been suggested in legal settings as an alternative cause of retinal hemorrhages (RHs) in young children who may have sustained abusive head trauma. We assessed the prevalence and characteristics of RHs in children with increased ICP. We conducted a prospecti...
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| Published in: | Pediatrics (Evanston) 2019-02, Vol.143 (2), p.1 |
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| container_issue | 2 |
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| container_title | Pediatrics (Evanston) |
| container_volume | 143 |
| creator | Shi, Angell Kulkarni, Abhaya Feldman, Kenneth W Weiss, Avery McCourt, Emily A Schloff, Susan Partington, Michael Forbes, Brian Geddie, Brooke E Bierbrauer, Karin Phillips, Paul H Rogers, David L Abed Alnabi, Waleed Binenbaum, Gil Levin, Alex V |
| description | Increased intracranial pressure (ICP) has been suggested in legal settings as an alternative cause of retinal hemorrhages (RHs) in young children who may have sustained abusive head trauma. We assessed the prevalence and characteristics of RHs in children with increased ICP.
We conducted a prospective, multicenter study of children |
| doi_str_mv | 10.1542/peds.2018-1182 |
| format | article |
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We conducted a prospective, multicenter study of children <4 years old with newly diagnosed increased ICP as determined by using direct measurement and/or clinical criteria. Infants who were premature, neonates, and suspected survivors of abusive head trauma were excluded on the basis of nonocular findings. Fundus examinations were performed; extent, number, and type of RH in each of 4 distinct retinal zones were recorded.
Fifty-six children (27 boys) were studied (mean age 15.4 months; range 1-43 months). All of the children had elevated ICP that required intervention. One child had papilledema. No child (0%; 95% confidence interval: 0%-6.4%) or eye (0%; 95% confidence interval: 0%-3.3%) was found to have an RH. Causes of increased ICP included hydrocephalus, intraventricular hemorrhage, congenital malformations, malfunctioning shunts, and the presence of intracranial space-occupying lesions.
Although acute increased ICP can present in children with a pattern of peripapillary superficial RHs in the presence of papilledema, our study supports the conclusion that RHs rarely occur in the absence of optic disc swelling and do not present beyond the peripapillary area in the entities we have studied.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2018-1182</identifier><identifier>PMID: 30630868</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Bypasses ; Child, Preschool ; Children ; Confidence intervals ; Congenital defects ; Control ; Craniocerebral Trauma - diagnosis ; Craniocerebral Trauma - epidemiology ; Craniocerebral Trauma - physiopathology ; Female ; Head injuries ; Health aspects ; Hemorrhage ; Humans ; Hydrocephalus ; Infant ; Infants ; Intracranial Hypertension - diagnosis ; Intracranial Hypertension - epidemiology ; Intracranial Hypertension - physiopathology ; Intracranial pressure ; Intracranial Pressure - physiology ; Lesions ; Male ; Neonates ; Optic nerve ; Pediatric research ; Pediatrics ; Pressure ; Prospective Studies ; Retina ; Retinal hemorrhage ; Retinal Hemorrhage - diagnosis ; Retinal Hemorrhage - epidemiology ; Retinal Hemorrhage - physiopathology ; Risk factors ; Shunts ; Swelling ; Trauma</subject><ispartof>Pediatrics (Evanston), 2019-02, Vol.143 (2), p.1</ispartof><rights>Copyright © 2019 by the American Academy of Pediatrics.</rights><rights>Copyright American Academy of Pediatrics Feb 2019</rights><rights>Copyright © 2019 by the American Academy of Pediatrics 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-fa5fa56c050280565f98de934f8c051f3233d636678eb54dc989fb409d589acb3</citedby><cites>FETCH-LOGICAL-c456t-fa5fa56c050280565f98de934f8c051f3233d636678eb54dc989fb409d589acb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30630868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shi, Angell</creatorcontrib><creatorcontrib>Kulkarni, Abhaya</creatorcontrib><creatorcontrib>Feldman, Kenneth W</creatorcontrib><creatorcontrib>Weiss, Avery</creatorcontrib><creatorcontrib>McCourt, Emily A</creatorcontrib><creatorcontrib>Schloff, Susan</creatorcontrib><creatorcontrib>Partington, Michael</creatorcontrib><creatorcontrib>Forbes, Brian</creatorcontrib><creatorcontrib>Geddie, Brooke E</creatorcontrib><creatorcontrib>Bierbrauer, Karin</creatorcontrib><creatorcontrib>Phillips, Paul H</creatorcontrib><creatorcontrib>Rogers, David L</creatorcontrib><creatorcontrib>Abed Alnabi, Waleed</creatorcontrib><creatorcontrib>Binenbaum, Gil</creatorcontrib><creatorcontrib>Levin, Alex V</creatorcontrib><title>Retinal Findings in Young Children With Increased Intracranial Pressure From Nontraumatic Causes</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Increased intracranial pressure (ICP) has been suggested in legal settings as an alternative cause of retinal hemorrhages (RHs) in young children who may have sustained abusive head trauma. We assessed the prevalence and characteristics of RHs in children with increased ICP.
We conducted a prospective, multicenter study of children <4 years old with newly diagnosed increased ICP as determined by using direct measurement and/or clinical criteria. Infants who were premature, neonates, and suspected survivors of abusive head trauma were excluded on the basis of nonocular findings. Fundus examinations were performed; extent, number, and type of RH in each of 4 distinct retinal zones were recorded.
Fifty-six children (27 boys) were studied (mean age 15.4 months; range 1-43 months). All of the children had elevated ICP that required intervention. One child had papilledema. No child (0%; 95% confidence interval: 0%-6.4%) or eye (0%; 95% confidence interval: 0%-3.3%) was found to have an RH. Causes of increased ICP included hydrocephalus, intraventricular hemorrhage, congenital malformations, malfunctioning shunts, and the presence of intracranial space-occupying lesions.
Although acute increased ICP can present in children with a pattern of peripapillary superficial RHs in the presence of papilledema, our study supports the conclusion that RHs rarely occur in the absence of optic disc swelling and do not present beyond the peripapillary area in the entities we have studied.</description><subject>Bypasses</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Confidence intervals</subject><subject>Congenital defects</subject><subject>Control</subject><subject>Craniocerebral Trauma - diagnosis</subject><subject>Craniocerebral Trauma - epidemiology</subject><subject>Craniocerebral Trauma - physiopathology</subject><subject>Female</subject><subject>Head injuries</subject><subject>Health aspects</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Hydrocephalus</subject><subject>Infant</subject><subject>Infants</subject><subject>Intracranial Hypertension - diagnosis</subject><subject>Intracranial Hypertension - epidemiology</subject><subject>Intracranial Hypertension - physiopathology</subject><subject>Intracranial pressure</subject><subject>Intracranial Pressure - physiology</subject><subject>Lesions</subject><subject>Male</subject><subject>Neonates</subject><subject>Optic nerve</subject><subject>Pediatric research</subject><subject>Pediatrics</subject><subject>Pressure</subject><subject>Prospective Studies</subject><subject>Retina</subject><subject>Retinal hemorrhage</subject><subject>Retinal Hemorrhage - diagnosis</subject><subject>Retinal Hemorrhage - epidemiology</subject><subject>Retinal Hemorrhage - physiopathology</subject><subject>Risk factors</subject><subject>Shunts</subject><subject>Swelling</subject><subject>Trauma</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNpdkdGL1DAQxoMo3nr66qMUfPGl66RJ2uRFOIqrB4cnoohPMZtOuznaZC9pRf97U_Y8VAgkZH7z8c18hDynsKWCV6-P2KVtBVSWlMrqAdlQULLkVSMekg0AoyUHEGfkSUo3AMBFUz0mZwxqBrKWG_L9E87Om7HYOd85P6TC-eJbWPxQtAc3dhF98dXNh-LS24gmYZdfczQ2Gu9y28eIKS0Ri10MU_EhrLVlMrOzRWuWhOkpedSbMeGzu_ucfNm9_dy-L6-u3122F1el5aKey96IfGoLAioJoha9kh0qxnuZ_2jPKsa6mtV1I3EveGeVVP2eg-qEVMbu2Tl5c9I9LvsJO4urk1Efo5tM_KWDcfrfincHPYQfOotSxnkWeHUnEMPtgmnWk0sWx9F4DEvSFW0UY5VQMqMv_0NvwhLzFldKZlNMiVWwPFGDGVE7b_Ny8OdswzjigDpP317rCyFBcg7Nym9PvI0hpYj9vXkKeg1br2HrNWy9hp0bXvw98j3-J132GykipYs</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Shi, Angell</creator><creator>Kulkarni, Abhaya</creator><creator>Feldman, Kenneth W</creator><creator>Weiss, Avery</creator><creator>McCourt, Emily A</creator><creator>Schloff, Susan</creator><creator>Partington, Michael</creator><creator>Forbes, Brian</creator><creator>Geddie, Brooke E</creator><creator>Bierbrauer, Karin</creator><creator>Phillips, Paul H</creator><creator>Rogers, David L</creator><creator>Abed Alnabi, Waleed</creator><creator>Binenbaum, Gil</creator><creator>Levin, Alex V</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201902</creationdate><title>Retinal Findings in Young Children With Increased Intracranial Pressure From Nontraumatic Causes</title><author>Shi, Angell ; Kulkarni, Abhaya ; Feldman, Kenneth W ; Weiss, Avery ; McCourt, Emily A ; Schloff, Susan ; Partington, Michael ; Forbes, Brian ; Geddie, Brooke E ; Bierbrauer, Karin ; Phillips, Paul H ; Rogers, David L ; Abed Alnabi, Waleed ; Binenbaum, Gil ; Levin, Alex V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-fa5fa56c050280565f98de934f8c051f3233d636678eb54dc989fb409d589acb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Bypasses</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Confidence intervals</topic><topic>Congenital defects</topic><topic>Control</topic><topic>Craniocerebral Trauma - diagnosis</topic><topic>Craniocerebral Trauma - epidemiology</topic><topic>Craniocerebral Trauma - physiopathology</topic><topic>Female</topic><topic>Head injuries</topic><topic>Health aspects</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Hydrocephalus</topic><topic>Infant</topic><topic>Infants</topic><topic>Intracranial Hypertension - diagnosis</topic><topic>Intracranial Hypertension - epidemiology</topic><topic>Intracranial Hypertension - physiopathology</topic><topic>Intracranial pressure</topic><topic>Intracranial Pressure - physiology</topic><topic>Lesions</topic><topic>Male</topic><topic>Neonates</topic><topic>Optic nerve</topic><topic>Pediatric research</topic><topic>Pediatrics</topic><topic>Pressure</topic><topic>Prospective Studies</topic><topic>Retina</topic><topic>Retinal hemorrhage</topic><topic>Retinal Hemorrhage - diagnosis</topic><topic>Retinal Hemorrhage - epidemiology</topic><topic>Retinal Hemorrhage - physiopathology</topic><topic>Risk factors</topic><topic>Shunts</topic><topic>Swelling</topic><topic>Trauma</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shi, Angell</creatorcontrib><creatorcontrib>Kulkarni, Abhaya</creatorcontrib><creatorcontrib>Feldman, Kenneth W</creatorcontrib><creatorcontrib>Weiss, Avery</creatorcontrib><creatorcontrib>McCourt, Emily A</creatorcontrib><creatorcontrib>Schloff, Susan</creatorcontrib><creatorcontrib>Partington, Michael</creatorcontrib><creatorcontrib>Forbes, Brian</creatorcontrib><creatorcontrib>Geddie, Brooke E</creatorcontrib><creatorcontrib>Bierbrauer, Karin</creatorcontrib><creatorcontrib>Phillips, Paul H</creatorcontrib><creatorcontrib>Rogers, David L</creatorcontrib><creatorcontrib>Abed Alnabi, Waleed</creatorcontrib><creatorcontrib>Binenbaum, Gil</creatorcontrib><creatorcontrib>Levin, Alex V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shi, Angell</au><au>Kulkarni, Abhaya</au><au>Feldman, Kenneth W</au><au>Weiss, Avery</au><au>McCourt, Emily A</au><au>Schloff, Susan</au><au>Partington, Michael</au><au>Forbes, Brian</au><au>Geddie, Brooke E</au><au>Bierbrauer, Karin</au><au>Phillips, Paul H</au><au>Rogers, David L</au><au>Abed Alnabi, Waleed</au><au>Binenbaum, Gil</au><au>Levin, Alex V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Retinal Findings in Young Children With Increased Intracranial Pressure From Nontraumatic Causes</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2019-02</date><risdate>2019</risdate><volume>143</volume><issue>2</issue><spage>1</spage><pages>1-</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><abstract>Increased intracranial pressure (ICP) has been suggested in legal settings as an alternative cause of retinal hemorrhages (RHs) in young children who may have sustained abusive head trauma. We assessed the prevalence and characteristics of RHs in children with increased ICP.
We conducted a prospective, multicenter study of children <4 years old with newly diagnosed increased ICP as determined by using direct measurement and/or clinical criteria. Infants who were premature, neonates, and suspected survivors of abusive head trauma were excluded on the basis of nonocular findings. Fundus examinations were performed; extent, number, and type of RH in each of 4 distinct retinal zones were recorded.
Fifty-six children (27 boys) were studied (mean age 15.4 months; range 1-43 months). All of the children had elevated ICP that required intervention. One child had papilledema. No child (0%; 95% confidence interval: 0%-6.4%) or eye (0%; 95% confidence interval: 0%-3.3%) was found to have an RH. Causes of increased ICP included hydrocephalus, intraventricular hemorrhage, congenital malformations, malfunctioning shunts, and the presence of intracranial space-occupying lesions.
Although acute increased ICP can present in children with a pattern of peripapillary superficial RHs in the presence of papilledema, our study supports the conclusion that RHs rarely occur in the absence of optic disc swelling and do not present beyond the peripapillary area in the entities we have studied.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>30630868</pmid><doi>10.1542/peds.2018-1182</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Bypasses Child, Preschool Children Confidence intervals Congenital defects Control Craniocerebral Trauma - diagnosis Craniocerebral Trauma - epidemiology Craniocerebral Trauma - physiopathology Female Head injuries Health aspects Hemorrhage Humans Hydrocephalus Infant Infants Intracranial Hypertension - diagnosis Intracranial Hypertension - epidemiology Intracranial Hypertension - physiopathology Intracranial pressure Intracranial Pressure - physiology Lesions Male Neonates Optic nerve Pediatric research Pediatrics Pressure Prospective Studies Retina Retinal hemorrhage Retinal Hemorrhage - diagnosis Retinal Hemorrhage - epidemiology Retinal Hemorrhage - physiopathology Risk factors Shunts Swelling Trauma |
| title | Retinal Findings in Young Children With Increased Intracranial Pressure From Nontraumatic Causes |
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