Retinale Blutungen beim nicht akzidentellen Schädel-Hirn-Trauma im Kindesalter

Zusammenfassung

Retinale Blutungen stellen eine der 3 Säulen bei der Diagnosestellung eines sog. Schütteltraumas oder nicht akzidentellen Schädel-Hirn-Traumas dar. Zusammen mit Subduralhämatomen und einer Enzephalopathie bilden sie die hierfür typische Trias. Der augenärztliche Befund retinaler Blutungen im Kindesalter hat daher neben einer medizinischen oft auch eine rechtliche Bedeutung. Dessen Beurteilung kann weitreichende Folgen für die betroffenen Kinder und deren Eltern haben und mit darüber entscheiden, ob die Kinder bei ihren Eltern aufwachsen werden oder nicht. Die Rolle des Augenarztes bei einem vermuteten Schütteltrauma wurde daher in der Literatur mehrfach kontrovers diskutiert. Der folgende Aufsatz soll die Differenzialdiagnosen retinaler Blutungen im Kindesalter sowie die Spezifität dieser Blutungen für ein nicht akzidentelles Schädel-Hirn-Trauma im Rahmen einer Kindesmisshandlung darstellen.

Abstract

Retinal haemorrhages are one of the three cardinal manifestations of the “shaken baby syndrome” or “non-accidental head injury” in childhood. The role of an ophthalmologist in suspected non-accidental head injury has not only medical but also legal aspects and has been discussed controversially in the literature. The differential diagnosis and the specificity of retinal haemorrhages in childhood for an abusive head trauma will be pointed out in this paper.

Schlüsselwörter

retinale Blutungen - nicht akzidentelles Schädel-Hirn-Trauma - Schütteltrauma - Kindesalter

Key words

retinal haemorrhage - non-accidental head injury - shaken baby syndrome - childhood

• Literatur

• 1 Saeed MU, Parmar DN, Ohri R. The role of an ophthalmologist in suspected non-accidental injury. Eye 2003; 17: 93-95
• 2 Matschke J. Historischer Überblick des nichtakzidentellen Schädel-Hirn-Traumas im Säuglings- und Kleinkindalter. Rechtsmedizin 2008; 18: 7-8
• 3 Aikman J. Cerebral hemorrhage in infant, aged eight months: recovery. Arch Pediatr 1928; 45: 56-58
• 4 Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. AJR 1946; 56: 163-173
• 5 Caffey J. On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child 1972; 124: 161-169
• 6 Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics 1974; 54: 396-403
• 7 Kempe CH, Silverman FN, Steele BF et al. The battered-child syndrome. JAMA 1962; 181: 17-24
• 8 Guthkelch A. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J 1971; 2: 430-431
• 9 Matschke J, Herrmann B, Sperhake J et al. Das Schütteltrauma-Syndrom. Dtsch Arztebl Int 2009; 106: 211-217
• 10 Barlow KM, Minns RA. Annual incidence of shaken impact syndrome in young children. Lancet 2000; 356: 1571-1572
• 11 Jayawant S, Rawlinson A, Gibbon F et al. Subdural haemorrhages in infants: population based study. BMJ 1998; 317: 1558-1561
• 12 Keenan HT, Runyan DK, Marshall SW et al. A population-based study of inflicted traumatic brain injury in young children. JAMA 2003; 290: 621-626
• 13 Kelly P, Farrant B. Shaken baby syndrome in New Zealand, 2000–2002. J Paediatr Child Health 2008; 44: 99-107
• 14 Talvik I, Metsvaht T, Leito K et al. Inflicted traumatic brain injury (iTBI) or shaken baby syndrome in Estonia. Acta Paediatr 2006; 95: 799-804
• 15 Minns RA, Brown JK. Neurological Perspectives of non-accidental Head Injury and Whiplash/Shaken Baby Syndrome: An Overview. In: Minns RA, Brown JK, eds. Shaking and Other Non-Accidental Head Injuries in Children. Clinics in Developmental Medicine. London: Mac Keith Press; 2005: 1-106
• 16 Duhaime AC, Thomas A. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 1987; 66: 409-415
• 17 Cory CZ, Jones BM. Can shaking alone cause fatal brain injury? A biomechanical assessment of the Duhaime shaken baby syndrome model. Med Sci Law 2003; 43: 317-333
• 18 Pierce MC, Bertocci G. Injury biomechanics and child abuse. Annu Rev Biomed Eng 2008; 10: 85-106
• 19 Prange M. Biomechanics of Traumatic Brain Injury in the Infant. Philadelphia: University of Pennsylvania; 2002
• 20 Squier W. The “Shaken Baby” syndrome: pathology and mechanisms. Acta Neuropathol 2011; 122: 519-542
• 21 Morad Y, Wygnansky-Jaffe T, Levin AV. Retinal haemorrhage in abusive head trauma. Clin Experiment Ophthalmol 2010; 38: 514-520
• 22 Levin A. Retinal Haemorrhage and Child Abuse. In: David T, ed. Recent Advances in Paediatrics. London: Churchill Livingstone; 2000: 151-219
• 23 Tyagi AK, Willshaw HE, Ainsworth JR. Unilateral retinal haemorrhages in non-accidental injury. Lancet 1997; 349: 1224
• 24 Morad Y, Kim YM, Armstrong DC et al. Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome. Am J Ophthalmol 2002; 134: 354-359
• 25 Greenwald M, Weiss A, Oesterle C et al. Traumatic retinoschisis in battered babies. Ophthalmology 1986; 93: 618-625
• 26 Wygnanski-Jaffe T, Levin AV, Shafiq A et al. Postmortem orbital findings in shaken baby syndrome. Am J Ophthalmol 2006; 142: 233-240
• 27 Sturm V, Landau K, Menke MN. Optical coherence tomography findings in Shaken Baby syndrome. Am J Ophthalmol 2008; 146: 363-368
• 28 Coats B, Binenbaum G, Peiffer RL et al. Ocular hemorrhage in single non-impact head rotations: a porcine model. Jackson Hole, Wyoming, USA: Second International Conference on Pediatric Abusive Head Trauma. 2009.
• 29 Bhola R, Cirovic S, Parson M et al. Modeling of the eye and orbit to simulate Shaken Baby syndrome. Invest Ophthalmol Vis Sci 2005; 46: E-Abstract 4090
• 30 Rangarajan N, Kamalakkannan SB, Hasija V et al. Finite element model of ocular injury in abusive head trauma. J AAPOS 2009; 13: 364-369
• 31 Terson A. De lʼhemorrhagie dans le corps vitre au cours de lʼhemorrhagie cerebrale. Clin Ophthalmol 1900; 6: 309-312
• 32 Kivlin JD, Simons KB, Lazoritz S et al. Shaken baby syndrome. Ophthalmology 2000; 107: 1246-1254
• 33 Tomasi LG, Rosman NP. Purtscher retinopathy in the battered child syndrome. Am J Dis Child 1975; 129: 1335-1337
• 34 Kaur B, Taylor D. Fundus hemorrhages in infancy. Surv Ophthalmol 1992; 37: 1-17
• 35 Emerson MV, Pieramici J, Stoessel KM et al. Incidence and rate of disappearance of retinal hemorrhage in newborns. Ophthalmology 2001; 108: 36-39
• 36 Bode-Jänisch S, Bültmann E, Hartmann H et al. Serious head injury in young children: birth trauma versus non-accidental head injury. Forensic Sci Int 2012; 14: e34-e38
• 37 Pollina J, Dias MS, Li V et al. Cranial birth injuries in term newborn infants. Pediatr Neurosurg 2001; 35: 113-119
• 38 Squier W. Pathology of neurological Abnormality in early Life. In: Busuttil A, Keeling JW, editors Paediatric Forensic Medicine and Pathology. Boca Raton: Taylor & Francis Group; 2009: 166-180
• 39 Hughes LA, May K, Talbot JF et al. Incidence, distribution, and duration of birth-related retinal hemorrhages: a prospective study. J AAPOS 2006; 10: 102-106
• 40 Reddy SC, Jackson N. Retinopathy in acute leukaemia at initial diagnosis: correlation of fundus lesions and haematological parameters. Acta Ophthalmol Scand 2004; 82: 81-85
• 41 Gago LC, Wegner RK, Capone jr. A et al. Intraretinal hemorrhages and chronic subdural effusions: glutaric aciduria type 1 can be mistaken for shaken baby syndrome. Retina 2003; 23: 724-726
• 42 Strauss KA, Puffenberger EG, Robinson DL et al. Type I glutaric aciduria, part 1: natural history of 77 patients. Am J Med Genet C Semin Med Genet 2003; 121?C: 38-52
• 43 Gilliland MG, Luckenbach MW. Are retinal hemorrhages found after resuscitation attempts? A study of the eyes of 169 children. Am J Forensic Med Pathol 1993; 14: 187-192
• 44 Goetting MG, Sowa B. Retinal hemorrhage after cardiopulmonary resuscitation in children: an etiologic reevaluation. Pediatrics 1990; 85: 585-588
• 45 Levin AV. Retinal hemorrhage in abusive head trauma. Pediatrics 2010; 126: 961-970
• 46 Gilles E, McGregor M, Levy-Clarke G. Retinal hemorrhage asymmetry in inflicted head injury: a clue to pathogenesis?. J Pediatr 2003; 143: 494-499
• 47 Lantz PE, Sinal SH, Stanton CA et al. Perimacular retinal folds from childhood head trauma. BMJ 2004; 328: 754-756
• 48 Lueder GT, Turner JW, Paschall R. Perimacular retinal folds simulating nonaccidental injury in an infant. Arch Ophthalmol 2006; 124: 1782-1783
• 49 Moran K, Reddie I, Jacobs M. Severe haemorrhagic retinopathy and traumatic retinoschisis in a 2 year old infant, after an 11 metre fall onto concrete. Acta Paediatr 2008; 97: 149
• 50 Gnanaraj L, Gilliland M, Yahya R et al. Ocular manifestations of crush head injury in children. Eye (Lond) 2007; 21: 5-10
• 51 Khan NM, Al-Dohayan ND, Al-Batiniji FS. Bilateral leukocoria in a patient with homozygous protein C deficiency. Saudi Med J 2007; 28: 1129-1132
• 52 Wiznia R, Price J. Vitreous hemorrhages and disseminated intravascular coagulation in the newborn. Am J Ophthalmol 1976; 82: 222-226