Evidence based case report

Perimacular retinal folds from childhood head trauma

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7442.754 (Published 25 March 2004)
Cite this as: BMJ 2004;328:754

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  1. P E Lantz, associate professor (plantz@wfubmc.edu)1,
  2. S H Sinal, professor2,
  3. C A Stanton, associate professor1,
  4. R G Weaver Jr, associate professor3
  1. 1Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
  2. 2Department of Paediatrics, Wake Forest University School of Medicine
  3. 3Department of Ophthalmology, Wake Forest University School of Medicine
  1. Correspondence to: P E Lantz
  • Accepted 28 January 2004

Introduction

A previously healthy 14 month old child was transferred to our medical centre with a severe head injury. The father had collected the boy and his 3 year old brother from their mother at his workplace car park and taken them home while their mother went to work. The children had been watching television while the father prepared dinner. After hearing something fall, the father found the boy on the floor with the television covering the right side of the head and anterior chest. A homemade television stand was partially across the child's lower legs. His older brother stated, “television fell.” As soon as the father removed the television, he noticed the child's head beginning to swell. A neighbour drove them to the local hospital. According to the father and the neighbour, the child never stopped breathing and no resuscitative efforts were attempted.

Cranial computed tomography showed extensive head injuries. He had soft tissue swelling of the scalp, diffuse cerebral oedema with a subdural haematoma overlying the frontal convexities and layering along the falx cerebri, a left sided skull fracture adjacent to a widely diastatic coronal suture, cerebral contusions beneath the fracture, and a rightward midline shift measuring 8 mm. The paediatric ophthalmologist described bilateral dot and blot intraretinal haemorrhages, preretinal haemorrhages, and perimacular retinal folds (1).


Embedded Image
Fig 1

Clinical image highlighting temporal portion of perimacular retinal fold at 2-3 o'clock area in left eye with a blood vessel bending over the fold (magnification x6)

The child's condition deteriorated, and he died 18 hours after the incident. Child Protective Services removed the 3 year old sibling from the home because the retinal haemorrhages and retinal folds were considered diagnostic of abusive head trauma from shaking. This action was taken despite the father's repeated detailed, consistent account provided to emergency staff, the …

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