van den Hoven C M L, van Berkestijn F M C, Russel-Kampschoer I M B, Karst W A, Voskuil-Kerkhof E S M
Universitair Medisch Centrum Utrecht, afd. Oogheelkunde, Utrecht.
Ned Tijdschr Geneeskd. 2016;160:D266.
Inflicted traumatic brain injury (ITBI) - a possible result of child abuse - is difficult to diagnose, yet the diagnosis bears great impact on patients and their relatives. The purpose of this paper is to describe ophthalmologic findings that can be seen in relation to ITBI. For exemplification, three different cases are described in detail. ITBI is diagnosed through a multidisciplinary approach by exclusion of other causes that could explain the clinical findings, and by linking factors that together raise a high suspicion of ITBI. The typical triad of ITBI includes intracerebral haemorrhage, encephalopathy and retinal haemorrhages. Therefore, detailed fundus examination by an ophthalmologist is important when ITBI is suspected. A pattern of bilateral, multiple retinal haemorrhages present in different retinal layers and widespread from posterior pole to the retinal periphery, is highly suspicious for ITBI, and contributes to the final diagnosis.
非意外性创伤性脑损伤(ITBI)——虐待儿童可能导致的结果——难以诊断,但该诊断对患者及其亲属影响重大。本文旨在描述与ITBI相关的眼科检查结果。为举例说明,详细描述了三个不同病例。ITBI通过多学科方法进行诊断,排除其他可解释临床发现的病因,并将共同高度怀疑ITBI的因素联系起来。ITBI的典型三联征包括脑内出血、脑病和视网膜出血。因此,怀疑ITBI时,眼科医生进行详细的眼底检查很重要。不同视网膜层出现双侧、多发性视网膜出血且从后极广泛延伸至视网膜周边的模式,高度怀疑为ITBI,并有助于最终诊断。