The prevalence of retinal hemorrhages in infants presenting with convulsions was studied at Hospital Universitari Sant Joan de Deu, Barcelona, Spain. Of 389 children seen in the accident and emergency epartment with convulsions, 182 aged 15 days to 2 years were admitted with a first convulsion over a 2-year period (May 2004-May 2006), and 2 had retinal hemorrhages. All infants were examined within 72 hours of admission by an ophthalmologist using indirect ophthalmoscopy. Both infants with retinal hemorrhages were diagnosed with shaken baby syndrome. Convulsions alone are unlikely to cause retinal hemorrhages in children <2 years of age. [1]

COMMENT. A similar prospective study at Sackler School of Medicine, Tel Aviv University. Israel examined 153 children (aged 2 months to 2 years) in the ED after a convulsive episode. One child was found with unilateral retinal hemorrhages following a simple febrile convulsion. No other reason for the hemorrhage was uncovered. It was concluded that retinal hemorrhages following a convulsive episode are rare and should trigger a search for other causes, including child abuse. [2]

In 2 cases of infants with hyponatremic seizures examined at Franklin Square Hospital, Baltimore, MD, retinal hemorrhages were an unexpected finding. Long bone fractures and subdural hematoma were associated in one case of shaken baby syndrome, and cerebral edema in case 2 was presumed to be the result of child abuse. Children with hyponatremic seizures are often neglected and are at risk of other forms of child abuse. [3]