Convulsions and retinal haemorrhage: should we look further? (Original Article).

Background and Aims: The prevalence of retinal haemorrhages after convulsions is not well established. As these haemorrhages are considered characteristic of child abuse, we investigated their occurrence after convulsive episodes to see whether the finding of haemorrhage should prompt further investigation.

Methods: Prospective study of 153 children (aged 2 months to 2 years), seen in the emergency department after a convulsive episode. After a thorough history and physical examination, a retinal examination was performed by an ophthalmologist. If findings were positive, further investigation was undertaken to rule out systemic disorder or child abuse.

Results: One child was found with unilateral retinal haemorrhages following an episode of a simple febrile convulsion. A thorough investigation uncovered no other reason for this finding.

Conclusion: Retinal haemorrhages following a convulsive episode are rare. Such a finding should trigger on extensive search for other reasons, including child abuse.

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Retinal haemorrhages in infancy and childhood are important clinical findings. They may result from a variety of systemic diseases as well as accidental and non-accidental injuries. In the absence of the former, the clinical sign of retinal haemorrhages is suspicious of physical child abuse. (1 2) It has been suggested that retinal haemorrhages with no sign of disease are sufficient to diagnose child abuse. (1)

The prevalence of retinal haemorrhage after convulsions remains unclear. Studies have concluded that the chances of developing haemorrhage after convulsions are low, (3 4) but these studies were too small to rule it out. We therefore conducted a large prospective study to estimate better the prevalence of this sign in children with convulsions. Our purpose was to help clinicians deal with a child …