For medical legal reasons it may be best to have these substantiated by an ophthalmologist. In subtle cases, the retinal hemorrhages may not be seen on direct ophthalmoscopy, thus, an ophthalmologist is usually needed to perform indirect ophthalmoscopy. Most retinal hemorrhages are not visible on CT scan. Thus, CT scan is not useful to rule out the presence of retinal hemorrhages. In an infant, this classically is seen in the shaken infant syndrome.
Blood also enters the subarachnoid space.
Thus, if an LP is performed, it will most likely be grossly bloody. The hypernatremia in this case is extreme and is what makes this case particularly interesting. One should be highly suspicious that this degree of hypernatremia may be long standing. Thus, a rapid correction of this hypernatremia may be clinically detrimental. It may be best to correct this slowly.