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Melissa A. Simon, Brian J. Forbes, Cindy W. Christian, Rebecca N. Ichord, Gui-shaung Ying, Kathleen Romero, Gil Binenbaum; Association Between Retinal Hemorrhage And Pediatric Brain Injury Patterns On Diffusion-weighted Magnetic Resonance Imaging. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1569.
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To evaluate associations between retinal hemorrhage (RH) severity and hypoxic-ischemic brain injury (HII) patterns shown by diffusion-weighted magnetic resonance imaging (DWI) in head trauma in young children.
Single-center consecutive cohort study of children under age 3 years, with inflicted or accidental head trauma, brain MRI within 1 week, and dilated fundus exam within 24 hours. All MRI images were re-analyzed and scored by two independent masked examiners for type, severity, and location of lesions, and HII patterns. HII criteria included multiple defined anatomic vascular distributions with diffusion restriction and/or cortical laminar necrosis. RH was graded 1 (none) to 5 (severe) by two ophthalmologists independently reviewing the medical record. Criteria for inflicted injury excluded eye findings.
45 children (16 accidental head injury, 29 inflicted) were studied; median age, 2.6 months (range 0.5-34). RH was present in 13 children (11 inflicted, 2 accidental). 43 had intracranial hemorrhage (ICH), and 2 did not (accidental trauma, no RH). HII patterns were seen with ICH in 10 subjects (predominant HII pattern in 7, mixed pattern in 3), all of who had inflicted injuries. Moderate to severe RH (scored 3 to 5) was present in 6/7 (86%) who had a predominant HII pattern with ICH, and 4/32 (16%) who had ICH without HII (p<0.001). RH severity was correlated with HII severity (Spearman 0.53, p<0.001) but not with ICH severity (Spearman -0.10, p=0.50). In multivariate regression analysis, HII severity was associated with RH score 3-5 (p=0.03) but ICH severity was not (p=0.31).
In a study using masked, structured evaluations of diffusion-weighted MRI films, increased RH severity was associated with HII brain injury. Severe RH was observed in the absence of HII but only in inflicted injury, and RH severity did not correlate with ICH severity. These findings suggest multiple mechanisms of traumatic injury, including one that causes both HII and more severe RH.
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