Reddy Aravind R, Clarke Michael, Long Vernon W
Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK.
Eur J Ophthalmol. 2010 Jul-Aug;20(4):799-801. doi: 10.1177/112067211002000427.
Retinal hemorrhages are an important sign in the setting of nonaccidental injury (NAI) (abusive head injury) in young infants and form a very important part of the evidence in support of the diagnosis. The diagnosis of NAI has serious social and legal implications. Other causes of retinal hemorrhages in an infant, such as birth trauma, accidental head injury, subarachnoid hemorrhage, other less common disorders of clotting, leukemia, and infections such as endocarditis, need to be considered and ruled out in making a diagnosis of NAI.
Descriptive case report.
A 5-week-old child presented with rapid onset of symptoms of drowsiness and hypotonia, unilateral retinal hemorrhages, and an intracranial hemorrhage in the posterior fossa. NAI was high on the list of differential diagnosis, which caused considerable anxiety in the parents. The cause of the intracranial hemorrhage only became apparent at repeat neuroimaging several weeks later.
The case is presented to point out arteriovenous malformation as a possible cause of retinal hemorrhages in this age group where an early diagnosis of the etiology is often not possible. A diagnosis of NAI, commonly associated with a similar clinical presentation, can have serious social and legal implications.
视网膜出血是婴幼儿非意外性损伤（NAI，虐待性头部损伤）的一个重要体征，是支持该诊断的重要证据组成部分。NAI的诊断具有严重的社会和法律意义。在诊断NAI时，需要考虑并排除婴儿视网膜出血的其他原因，如出生创伤、意外头部损伤、蛛网膜下腔出血、其他不太常见的凝血障碍、白血病以及感染（如心内膜炎）。
描述性病例报告。
一名5周大的儿童出现嗜睡和肌张力减退症状迅速发作、单侧视网膜出血以及后颅窝颅内出血。NAI在鉴别诊断清单中排在前列，这给家长带来了相当大的焦虑。颅内出血的原因在数周后的重复神经影像学检查中才变得明显。
呈现该病例是为了指出动静脉畸形是这个年龄组视网膜出血的一个可能原因，在这个年龄组中病因往往无法早期诊断。通常与类似临床表现相关的NAI诊断可能具有严重的社会和法律意义。
