In a comprehensive review of 62 studies comprising 998 children, 504 of whom were abused, RH were found in 78% of cases of abusive head trauma (AHT) versus 5% of the cases of non-abusive head trauma. In a child with head trauma and RH, the odds ratio that this is AHT is 14.7 (95% CI 6.39, 33.62) and the probability of abuse is 91%. Where recorded, RH were bilateral in 83% of AHT cases compared to 8.3% in non-abusive cases.The generally accepted body of medical literature is strongly in favor of the tight association between retinal hemorrhages and child abuse, and there is no controversy among mainstream medicine. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. These theories are perpetuated by a small group of fringe doctors regularly testifying for the defense in cases of child abuse, citing case reports and weak scientific papers, that RH is not caused by shaking. Diagnosis
A retinal hemorrhage is generally diagnosed by using an ophthalmoscope or fundus camera in order to examine the inside of the eye. A fluorescein angiography test may be conducted, in which a fluorescent dye is often injected into the patients bloodstream beforehand so the administering ophthalmologist can have a more detailed view and examination on the blood vessels in the retina.
Pemphigus vegetans is a localized form of pemphigus vulgaris. in which there is a localized vegetating papillomatous response. The eroded areas do not heal like usual but form papillomatous growth and vegetation. Accounts for 1-2% of pemphigus cases and is a relatively benign variant of pemphigus vulgaris. Two forms are recognized:

Pemphigus vegetans of Neumann is a localized disease of pemphigus vulgaris slightly more extensive than pemphigus vegetans of Hallopeau. : 568  This type is more common and characterized by early lesions similar to Pemphigus Vulgaris with large bullae and erosive areas. Healing is through formation of granulation tissue. It is named for the Austrian Dermatologist, Isidor Neumann. Pemphigus vegetans of Hallopeau is a disease of localized pemphigus vulgaris. : 568  It is named for François Henri Hallopeau. This type is less aggressive and has pustules not bullae. These pustules heal by verrucous hyperkeratotic vegetations. See also
List of cutaneous conditions
Pemphigus
List of conditions caused by problems with junctional proteins

References


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