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Retinale Blutungen beim Schütteltrauma

Differenzialdiagnostische Aspekte

Retinal hemorrhages in shaken baby syndrome

Differential diagnostic aspects

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Zusammenfassung

Hintergrund

Die Beurteilung retinaler Blutungen spielt eine wichtige Rolle, wenn der Verdacht auf Kindesmisshandlung besteht.

Fragestellung

Darstellung der Charakteristika retinaler Blutungen beim Schütteltrauma („shaken baby syndrome“, SBS) sowie von Unterscheidungsmerkmalen zwischen retinalen Blutungen beim SBS und bei Purtscher-Retinopathie, Terson-Syndrom, geburts- und durch Unfälle bedingten retinalen Blutungen.

Material und Methoden

Literaturrecherche, Gegenüberstellung der Charakteristika retinaler Blutungen von SBS und den oben genannten Differenzialdiagnosen.

Ergebnisse

Retinale Blutungen beim SBS sind häufig bilateral und in großer Zahl vorhanden, reichen typischerweise bis in die Peripherie und können in allen Netzhautschichten liegen. Dahingegen sind bei der Purtscher-Retinopathie Cotton-wool-Herde typisch. Das Terson-Syndrom kommt im Kindesalter selten vor, und die Blutungen sind häufiger präretinal lokalisiert. Geburtsbedingte retinale Blutungen liegen vorwiegend am hinteren Pol und werden zumeist innerhalb eines Monats resorbiert. Durch einen Unfall bedingte retinale Blutungen setzen ein schweres Schädel-Hirn-Trauma voraus und sind in der Regel weniger ausgeprägt als beim SBS.

Schlussfolgerung

Verschiedene Unterscheidungsmerkmale können die Abgrenzung eines SBS zu anderen Differenzialdiagnosen retinaler Blutungen erleichtern. Ein für das SBS pathognomonisches Zeichen gibt es nicht. Jedoch lässt die Kombination von Subduralblutung, retinalen Blutungen mit typischen Charakteristika und fehlenden Zeichen einer äußeren Kopfverletzung eine Kindesmisshandlung als sehr wahrscheinlich erscheinen.

Abstract

Background

Ophthalmological assessment of retinal hemorrhages plays an important role when child abuse is suspected.

Objective

Presentation of characteristics of retinal hemorrhages in shaken baby syndrome (SBS) and of features that help to distinguish retinal hemorrhages in children with SBS from retinal hemorrhages in patients with Purtscher’s retinopathy, Terson’s syndrome, birth-related retinal hemorrhages and accidental head injury.

Methods

Literature search, summary of features that help to distinguish retinal hemorrhages in children with SBS from the abovenamed differential diagnoses.

Results

Retinal hemorrhages in children with SBS are typically bilateral, numerous, extend to the periphery and usually present in all layers of the retina. In contrast, in Purtscher’s retinopathy cotton wool spots are the most typical characteristics. Terson’s syndrome is rarely seen in childhood and hemorrhages are more often localized preretinally, while birth-related retinal hemorrhages in newborns are often restricted to the posterior pole and mostly resolve within 1 month. Retinal hemorrhages caused by accidental head injury are expressed to a lesser degree and can only be caused by severe head injury.

Conclusion

Several distinctive features enable a differentiation between SBS and other causes of retinal hemorrhages. There is, however, no pathognomonic sign for SBS. Nevertheless, if the combination of subdural hemorrhage and retinal hemorrhages with typical characteristics is seen in the absence of signs of an external head injury, child abuse is the most likely cause.

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Authors and Affiliations

  1. Augenklinik und Poliklinik, Universitätsklinikum Würzburg, Julius-Maximilians-Universität, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland

    A. Homa &  M. Nentwich

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Correspondence to M. Nentwich.

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A. Homa und M. Nentwich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Homa, A., Nentwich, M. Retinale Blutungen beim Schütteltrauma. Rechtsmedizin 28, 500–506 (2018). https://doi.org/10.1007/s00194-018-0277-z

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