Retinale Blutungen beim nicht akzidentellen Schädel-Hirn-Trauma im Kindesalter

 

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Zusammenfassung

Retinale Blutungen stellen eine der 3 Säulen bei der Diagnosestellung eines sog. Schütteltraumas oder nicht akzidentellen Schädel-Hirn-Traumas dar. Zusammen mit Subduralhämatomen und einer Enzephalopathie bilden sie die hierfür typische Trias. Der augenärztliche Befund retinaler Blutungen im Kindesalter hat daher neben einer medizinischen oft auch eine rechtliche Bedeutung. Dessen Beurteilung kann weitreichende Folgen für die betroffenen Kinder und deren Eltern haben und mit darüber entscheiden, ob die Kinder bei ihren Eltern aufwachsen werden oder nicht. Die Rolle des Augenarztes bei einem vermuteten Schütteltrauma wurde daher in der Literatur mehrfach kontrovers diskutiert. Der folgende Aufsatz soll die Differenzialdiagnosen retinaler Blutungen im Kindesalter sowie die Spezifität dieser Blutungen für ein nicht akzidentelles Schädel-Hirn-Trauma im Rahmen einer Kindesmisshandlung darstellen.

Abstract

Retinal haemorrhages are one of the three cardinal manifestations of the “shaken baby syndrome” or “non-accidental head injury” in childhood. The role of an ophthalmologist in suspected non-accidental head injury has not only medical but also legal aspects and has been discussed controversially in the literature. The differential diagnosis and the specificity of retinal haemorrhages in childhood for an abusive head trauma will be pointed out in this paper.

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