Correlation between retinal abnormalitie and intracranial abnormalitie in the haken baby yndrome

PURPOE: To report correlation between retinal and intracranial abnormalitie and to evaluate pathogenei of retinal hemorrhage in the haken baby yndrome (B). DEIGN: Obervational cae erie. METHOD: eventy-five children with apparent nonaccidental head trauma conitent with B had complete phyical examination, complete ophthalmologic examination, neuroimaging by CT or MRI, or both, and keletal radiographic urvey. In thi retropective review, ophthalmocopic and intracranial abnormalitie were correlated. REULT: The age of patient ranged from 2 to 48 month (mean - D, 10.6 ± 10.4 month). Neuroimaging wa abnormal in all 75 cae. Finding included ubdural hematoma (70 children, 93%), cerebral edema (33 children, 44%), ubarachnoid hemorrhage (12 children, 16%), vacular infarction (nine children, 12%), intraparenchymal blood (ix children, 8%), parenchymal contuion (ix children, 8%), and epidural hemorrhage (one child, 1%). ixty-four (64/75, 85%) children had retinal abnormalitie, motly (53/64, 82%) confluent multiple hemorrhage that were ubretinal, intraretinal, and preretinal in 47/64 (74%) and bilateral in 52/64 (81%). No aociation wa found between anatomic ite (left, right, or bilateral) of intracranial and retinal finding (McNemar tet KAPPA = −0.026–0.106) or between any of the intracranial finding mentioned above and the following retinal finding: normal or abnormal retinal examination, multiple (>10) or few retinal hemorrhage (≤10), ymmetric or aymmetric retinal finding, or retinochii (kappa = −0.127–0.104). ign of poible increaed intracranial preure were not correlated with any retinal abnormality (kappa = −0.03–0.073). There wa no correlation between evidence of impact trauma to the head and retinal hemorrhage (kappa = 0.058). Total Cranial Trauma core and Total Retinal Hemorrhage core, both indicating the everity of injury, were correlated (P = .032). CONCLUION: Our tudy upport previou obervation that the everity of retinal and intracranial injury i correlated in B. We cannot upport the uggetion that in mot children with B retinal bleeding i caued by utained elevated intracranial, elevated intrathoracic preure, direct tracking of blood from the intracranial pace, or direct impact trauma. The correlation in everity of both eye and head finding may ugget, however, that retinal abnormalitie are the reult of mechanical haking force.