Hellgren Kerstin, Fahnehjelm Kristina
docent, överläkare , institutionen för klinisk neurovetenskap, Karolinska institutet; PF Barnneurologi och barnneurokirurgi, Tema barn och kvinnosjukvård, Karolins-ka universitetssjukhuset, Stockholm.
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Lakartidningen. 2020 May 29;117:19239.
Brain injuries due to abusive head trauma (AHT) in infants are not rare and they are probably under-diagnosed. Retinal hemorrhages (RH) constitute a cardinal symptom of AHT and AHT is the most common cause of RH in infants next to childbirth. Retinoschisis with or without retinal folds is highly suggestive of AHT and never seen secondary to childbirth. Bilateral extensive RH that are too numerous to count, multilayered and extending to the peripheral retina in infants < 3 years of age, in combination with brain injury and in absence of leukemia, ruptured brain aneurysm/AVM, fatal head crush or known severe accidental trauma must be considered to be caused by AHT in the absence of any other compelling factors. The ophthalmologist has an important role and a responsibility in describing the pattern of RH and in evaluating the likelihood of the diagnosis in the medical report and in communication with pediatricians and child protection team.
婴儿因虐待性头部外伤（AHT）导致的脑损伤并不罕见，而且可能存在诊断不足的情况。视网膜出血（RH）是AHT的主要症状，AHT是婴儿RH的第二大常见原因，仅次于分娩。伴有或不伴有视网膜皱襞的视网膜劈裂高度提示AHT，从未见于分娩继发情况。3岁以下婴儿出现双侧广泛的RH，多得数不清、多层且延伸至周边视网膜，同时伴有脑损伤，且无白血病、脑动脉瘤/动静脉畸形破裂、致命性头部挤压或已知的严重意外创伤，在没有任何其他令人信服因素的情况下，必须考虑由AHT引起。眼科医生在描述RH模式以及在医疗报告中评估诊断可能性并与儿科医生和儿童保护团队沟通方面起着重要作用并负有责任。
