Gaurav Bhardwaj, Mark Jacobs, Frank Martin, Craig Donaldson, Kieran Moran, Vivek Chowdhury, Minas Coroneo
Purpose: To report, objectively, the nature of retinal changes in infants following a non-traumatic acute rise in intracranial pressure (ICP).
Methods: This was a prospective, consecutive, case series of infants and children (4 weeks – 3 years) admitted with any condition causing an acute rise in ICP. Determination of raised ICP was made by neuro-surgical or radiological assessment, or ICP monitoring. All patients received a mydriatic fundus exam as soon as possible following admission and wide-field retinal images were obtained with RetCam in all possible cases. Images were independently graded by two masked experts for presence of intraocular haemor-rhages (IOH), papilloedema and retinal venous tortu-osity or dilatation.
Results: There were 17 patients included in the series. Causes of raised ICP included obstructive hydrocepha-lus in 11 cases, spontaneous intracranial haemorrhage or extra-axial effusion in 3 cases, and cerebral oedema in 3 cases. IOH were seen in 3/17 (18%) cases. IOH were severe in a case with subarachnoid haemorrhage from a ruptured aneurysm. There were no cases with retinal venous dilatation or definite papilloedema.
Conclusion: Rise in ICP in the absence of intracranial haemorrhage does not appear to cause severe haemor-rhagic retinopathy. Papilloedema appears to be rare in the acute paediatric setting.