Abstract
Retinal hemorrhages have long been recognized as a clue to the presence of inflicted head injury in children. The precise mechanism by which this occurs has not been totally understood. A step in this direction is reported in this issue of The Journal by Gilles and associates from Children's Hospital in Los Angeles. These workers used a database containing serial fundus photographs and brain imaging in 14 children with inflicted head injury, 10 of whom had retinal hemorrhages. In most cases, there was good correlation between the laterality of the initial fundus findings and the localization of injury on computed tomography (CT) imaging. In some cases, it was a matter of time before the lateralization became evident on CT, although it could be predicted by the initial appearance of the fundus. This observation supports the hypothesis that retinal findings in children with inflicted head injury are consequent to the transmission of intracranial pressure gradients to the retinal sheath and vessels. In addition to providing the practitioner with a nice review of the effects of these injuries in children, the paper is an example of the use of careful clinical examinations in testing complex physiologic hypotheses.
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