Increased Intracranial Pressure Does Not Cause Retinal Hemorrhages Characteristic of Abuse

In young children, severe retinal hemorrhages are associated with abusive head trauma and can be important in abuse recognition by clinicians, family members, and social and legal professionals. In court, the theory that retinal hemorrhages can be caused by elevated intracranial pressure (ICP) alone is often put forward in an attempt to discount their significance.

These authors prospectively examined 56 children aged <4 years from nine tertiary pediatric referral centers who had nontraumatic elevations of ICP. Participants were identified by convenience sampling from 2008 to 2017. Elevated ICP was identified by clinical signs in all 56 patients and by direct measurement in 19.

The most common causes of elevated ICP were brain tumors, primary…