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Christian CW, Binenbaum G. The eye in child abuse. Childs Nerv Syst 2022; 38:2335-2344. [PMID: 35871261 DOI: 10.1007/s00381-022-05610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
Child physical abuse may result in a range of injuries to the globe and surrounding tissues. These injuries have varying degrees of specificity for abuse, and no pattern of injury is unique to abuse. Easily overlooked eye injuries in non-ambulatory infants often portend more severe abuse and require careful evaluation for occult injury when they are unexplained. Retinal hemorrhages are most often a sign of significant trauma and the severity of the hemorrhages generally parallels the severity of neurological trauma. Ophthalmologists contribute important data that more easily distinguish medical disease from trauma, but caution is needed in differentiating accidental from inflicted trauma. This distinction requires careful consideration of the complete clinical data and occasionally on additional law enforcement or child welfare investigation.
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Affiliation(s)
- Cindy W Christian
- The Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Department of Pediatrics, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA.
| | - Gil Binenbaum
- The Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Ophthalmology, The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, USA
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Dettmeyer R, Ohlwärther T, Birngruber CG, Lang J. Histopathologische Diagnostik beim letalen Schütteltrauma. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0278-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
PURPOSE To demonstrate vitreoretinal traction as a mechanism for perimacular folds in abusive head trauma. METHODS We performed gross and histopathologic examination of eyes of children with suspected abusive head trauma and identified those with typical perimacular folds. Information was collected regarding the incident that led to the child's death and systemic manifestations noted at autopsy. Eyes were prepared in a fashion that allowed for demonstration of the vitreoretinal interface. RESULTS Ten eyes of five patients (2-13 months) were examined. All patients had systemic manifestations of abusive trauma including intracranial injury. All cases provided evidence of vitreoretinal traction producing perimacular folds. Condensed vitreous was seen attached to the apices of the retinal folds, and the detached internal limiting membrane comprising the inner surfaces of the schisis cavity. Four cases showed severe bilateral multilayered symmetric retinal hemorrhages extending to the ora serrata. All cases showed optic nerve sheath subdural hemorrhage and subarachnoid hemorrhage. Orbital hemorrhage was unilateral in two cases and bilateral in three cases. Four cases showed orbital fat hemorrhage. One case showed extraocular muscle sheath and cranial nerve sheath hemorrhage. Two cases showed juxtapapillary intrascleral hemorrhage. CONCLUSION Vitreoretinal traction is the likely mechanism of perimacular folds in abusive head trauma.
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Del Bigio MR, Phillips SM. Retroocular and Subdural Hemorrhage or Hemosiderin Deposits in Pediatric Autopsies. J Neuropathol Exp Neurol 2017; 76:313-322. [PMID: 28340081 DOI: 10.1093/jnen/nlx010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The presence of hemosiderin in the optic nerve sheath and/or retina is sometimes used to estimate the timing of injury in infants or children with suspected non-accidental head trauma. To determine the prevalence of hemosiderin in deaths not associated with trauma, we performed a prospective study of retroocular orbital tissue, cranial convexity, and cervical spinal cord dura mater in infants and children <2.5 years age. In 53 cases of non-traumatic death, approximately 70% had blood or hemosiderin within the orbital fat, ocular muscles, and parasagittal cranial and/or cervical spinal subdural compartment. This bleeding is likely a consequence of the birth process. None had evidence of hemorrhage within the optic nerve sheath. Premature birth was less likely associated with orbital tissue hemorrhage. Caesarean section birth (mainly nonelective) was not associated with lower prevalence. Residual hemosiderin was identifiable up to 36 weeks postnatal age, suggesting gradual disappearance after birth. Cardiopulmonary resuscitation (performed in the majority of cases) was not associated with acute hemorrhage. In 9 traumatic deaths, 6 had blood and/or hemosiderin within the optic nerve sheath. Knowledge of the potential presence and resolution of hemosiderin in these locations is important for medicolegal interpretation of childhood deaths associated with head or brain injury.
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Affiliation(s)
- Marc R Del Bigio
- Department of Pathology, University of Manitoba, Winnipeg, Canada.,Diagnostic Services Manitoba, Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Manitoba, Winnipeg, Canada
| | - Susan M Phillips
- Department of Pathology, University of Manitoba, Winnipeg, Canada.,Diagnostic Services Manitoba, Manitoba, Winnipeg, Canada
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Isawumi MA, Adebayo M. Child Abuse and the Eye in an African Population. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:143-150. [PMID: 28367043 PMCID: PMC5368088 DOI: 10.3341/kjo.2017.31.2.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/14/2016] [Indexed: 12/05/2022] Open
Abstract
Purpose There is a paucity of data on child abuse and the eye in West Africa. Therefore, a need exists to determine the causes and circumstances surrounding these occurrences and their effects on the eye and vision in a pediatric population. Methods A 3-year study of consecutive cases of ocular features that presented to an eye clinic following a history suggestive of child abuse along with any associated eye injury was carried out. Socio-demographic characteristics were obtained, as were the presenting and posttreatment visual acuity, and a full clinical eye examination was also done. Results Fifty-six children with 56 affected eyes were examined. The male to female ratio was 1.8 : 1; the mean age was 8.25 ± 3.5 years; and the subjects were predominately primary school children 30 (53.6%). The most common ocular disorders were conjunctiva hyperemia (46.4%), corneal abrasion/ulcer (25.4%), hyphema/uveitis (42.9%), retinal detachment (7.1%), sclera rupture (7.1%), and globe perforation (21.4%). The intraocular pressure was raised in 17.9% of participants. Presenting versus posttreatment visual acuities showed normal vision in four (7.1%) vs. eighteen (32.1%), visual impairment in 12 (21.4%) vs. six (10.7%), severe visual impairment in 20 (35.7%) vs. 12 (21.4%), and blindness in 12 (21.4%) vs. 14 (25%), p < 0.001. The most common injurious agents were canes (25.0%) and sticks (17.9%). The people who inflicted the injuries were parents/relatives (uncles) in 35.7% of cases and the children themselves (accidents) in 21.4% of cases. Circumstances predisposing participants to eye injuries were child labor in 39.3% and beatings in 25.0%. Complications were cataracts (25.0%), corneal opacity (39.3%), and retinal detachment (7.1%). Conclusions Injuries commonly resulted from canes and sticks used during beatings, as well as from child labor, corporal punishment, accidents, and assaults. Legislation and laws need to be enacted to prevent negative psychosocial and economic impacts on the child, family and country as a whole.
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Affiliation(s)
- Michaeline A Isawumi
- Department of Surgery, College of Health Sciences, Osun State University, Osogbo, Nigeria.; Department of Ophthalmology, LAUTECH Teaching Hospital, Osogbo, Nigeria
| | - Modupe Adebayo
- Department of Ophthalmology, LAUTECH Teaching Hospital, Osogbo, Nigeria
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6
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Bais B, Karst WA, Kubat B, Verdijk RM. Persistent Retinal Iron in Abusive Head Trauma. J Forensic Sci 2016; 61:1693-1696. [DOI: 10.1111/1556-4029.13215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 02/02/2016] [Accepted: 02/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Babette Bais
- Department of Forensic Medicine; Netherlands Forensic Institute; The Hague The Netherlands
| | - Wouter A. Karst
- Department of Forensic Medicine; Netherlands Forensic Institute; The Hague The Netherlands
| | - Bela Kubat
- Department of Forensic Medicine; Netherlands Forensic Institute; The Hague The Netherlands
| | - Robert M. Verdijk
- Department of Pathology; Section Ophthalmic Pathology; Erasmus MC University Medical Center; Rotterdam The Netherlands
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Leeuw MD, Beuls E, Jorens PG, Parizel P, Jacobs W. The optic nerve sheath hemorrhage is a non-specific finding in cases of suspected child abuse. J Forensic Leg Med 2015; 36:43-8. [PMID: 26386200 DOI: 10.1016/j.jflm.2015.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 05/12/2015] [Accepted: 08/24/2015] [Indexed: 11/27/2022]
Abstract
In young infants, the triad consisting of acute encephalopathy, retinal hemorrhages, and a subdural hematoma is a nonspecific finding. It has traumatic and non-traumatic etiologies. The triad may be found among a vast spectrum of natural diseases. Optic nerve sheath hemorrhage in infants is typically detected at autopsy. It is a nonspecific finding that can be found in traumatic and non-traumatic etiologies. Neither the triad nor the ONSH are pathognomonic for an abusive head injury. Opposite to the triad, the spectrum of non-traumatic etiologies of ONSH is limited. In infants ONSH rarely occurs in spontaneous subarachnoidal hemorrhage or in infectious conditions. Our results show that the clinical significance of the optic nerve sheath hemorrhage in the forensic work-up of fatal cases of alleged abusive head injury is its limited differential diagnosis. Only after careful differential diagnosis ONSH may contribute to the diagnosis of AHT. However, the main limitation of our study is the sampling bias, as the eyes are usually removed when abusive head trauma is suspected.
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Affiliation(s)
- Marc De Leeuw
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium; Community Hospital Aalst, Merestraat 80, B-9300 Aalst, Belgium; Decanaat University of Gent, De pintelaan, 185, 9000 Gent, Belgium
| | - Emile Beuls
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp Wilrijkstraat 10, B-2650 Edegem, Belgium
| | - Paul Parizel
- Department of Radiology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium
| | - Werner Jacobs
- Department of Forensic Medicine and Pathology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium
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Chan V, Mann RE, Pole JD, Colantonio A. Children and youth with 'unspecified injury to the head': implications for traumatic brain injury research and surveillance. Emerg Themes Epidemiol 2015; 12:9. [PMID: 26113870 PMCID: PMC4480889 DOI: 10.1186/s12982-015-0031-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background The case definition for traumatic brain injury (TBI) often includes ‘unspecified injury to the head’ diagnostic codes. However, research has shown that the inclusion of these codes leads to false positives. As such, it is important to determine the degree to which inclusion of these codes affect the overall numbers and profiles of the TBI population. The objective of this paper was to profile and compare the demographic and clinical characteristics, intention and mechanism of injury, and discharge disposition of hospitalized children and youth aged 19 years and under using (1) an inclusive TBI case definition that included ‘unspecified injury to the head’ diagnostic codes, (2) a restricted TBI case definition that excluded ‘unspecified injury to the head ‘diagnostic codes, and (3) the ‘unspecified injury to the head’ only case definition. Methods The National Ambulatory Care Reporting System and the Discharge Abstract Database from Ontario, Canada, were used to identify cases between fiscal years 2003/04 and 2009/10. Results The rate of TBI episodes of care using the inclusive case definition for TBI (2,667.2 per 100,000) was 1.65 times higher than that of the restricted case definition (1,613.3 per 100,000). ‘Unspecified injury to the head’ diagnostic codes made up of 39.5 % of all cases identified with the inclusive case definition. Exclusion of ‘unspecified injury to the head’ diagnostic code in the TBI case definition resulted in a significantly higher proportion of patients in the intensive care units (p < .0001; 18.5 % vs. 22.2 %) and discharged to a non-home setting (p < .0001; 9.9 % vs. 11.6 %). Conclusion Inclusion of ‘unspecified injury to the head’ diagnostic codes resulted in significant changes in numbers, healthcare use, and causes of TBI. Careful consideration of the inclusion of ‘unspecified injury to the head’ diagnostic codes in the case definition of TBI for the children and youth population is important, as it has implications for the numbers used for policy, resource allocation, prevention, and planning of healthcare services. This paper can inform future work on reaching consensus on the diagnostic codes for defining TBI in children and youth.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada ; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada ; Pediatric Oncology Group of Ontario, Toronto, ON Canada
| | - Robert E Mann
- Centre for Addiction and Mental Health, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada ; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada ; Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Wittschieber D, Karger B, Niederstadt T, Pfeiffer H, Hahnemann ML. Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications. AJNR Am J Neuroradiol 2015; 36:432-9. [PMID: 24948499 PMCID: PMC8013070 DOI: 10.3174/ajnr.a3989] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Are subdural hygromas the result of abusive head trauma? CT and MR imaging represent important tools for the diagnosis of abusive head trauma in living infants. In addition, in-depth understanding of the pathogenesis of subdural hygromas is increasingly required by neuroradiologists, pediatricians, and forensic physicians. Therefore, the current knowledge on subdural hygromas is summarized and forensic conclusions are drawn. The most important diagnostic pitfalls, benign enlargement of the subarachnoid space, and chronic subdural hematoma, are discussed in detail. Illustrative cases from forensic practice are presented. Literature analysis indicates that subdural hygromas can occur immediately or be delayed. If other infrequent reasons can be excluded, the presence of subdural hygromas strongly suggests a posttraumatic state and should prompt the physician to search for other signs of abuse. To differentiate subdural hygromas from other pathologies, additional MR imaging of the infant's head is indispensable after initial CT scan.
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Affiliation(s)
- D Wittschieber
- From the Departments of Forensic Medicine (D.W., B.K., H.P.)
| | - B Karger
- From the Departments of Forensic Medicine (D.W., B.K., H.P.)
| | - T Niederstadt
- Clinical Radiology (T.N.), University Hospital Münster, Münster, Germany
| | - H Pfeiffer
- From the Departments of Forensic Medicine (D.W., B.K., H.P.)
| | - M L Hahnemann
- Department of Diagnostic and Interventional Radiology and Neuroradiology (M.L.H.), University Hospital Essen, Essen, Germany
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Chan V, Thurairajah P, Colantonio A. Defining pediatric traumatic brain injury using International Classification of Diseases Version 10 Codes: a systematic review. BMC Neurol 2015; 15:7. [PMID: 25648197 PMCID: PMC4335539 DOI: 10.1186/s12883-015-0259-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/07/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although healthcare administrative data are commonly used for traumatic brain injury (TBI) research, there is currently no consensus or consistency on the International Classification of Diseases Version 10 (ICD-10) codes used to define TBI among children and youth internationally. This study systematically reviewed the literature to explore the range of ICD-10 codes that are used to define TBI in this population. The identification of the range of ICD-10 codes to define this population in administrative data is crucial, as it has implications for policy, resource allocation, planning of healthcare services, and prevention strategies. METHODS The databases MEDLINE, MEDLINE In-Process, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Database of Systematic Reviews were systematically searched. Grey literature was searched using Grey Matters and Google. Reference lists of included articles were also searched for relevant studies. Two reviewers independently screened all titles and abstracts using pre-defined inclusion and exclusion criteria. A full text screen was conducted on articles that met the first screen inclusion criteria. All full text articles that met the pre-defined inclusion criteria were included for analysis in this systematic review. RESULTS A total of 1,326 publications were identified through the predetermined search strategy and 32 articles/reports met all eligibility criteria for inclusion in this review. Five articles specifically examined children and youth aged 19 years or under with TBI. ICD-10 case definitions ranged from the broad injuries to the head codes (ICD-10 S00 to S09) to concussion only (S06.0). There was overwhelming consensus on the inclusion of ICD-10 code S06, intracranial injury, while codes S00 (superficial injury of the head), S03 (dislocation, sprain, and strain of joints and ligaments of head), and S05 (injury of eye and orbit) were only used by articles that examined head injury, none of which specifically examined children and youth. CONCLUSION This review provides evidence for discussion on how best to use ICD codes for different goals. This is an important first step in reaching an appropriate definition and can inform future work on reaching consensus on the ICD-10 codes to define TBI for this vulnerable population.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Pravheen Thurairajah
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
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Bhagat S, Mikhail M, Boyle N. Rupture of Descemet's membrane secondary to presumed non-accidental injury. Eye (Lond) 2015; 29:716-8. [PMID: 25613843 DOI: 10.1038/eye.2014.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- S Bhagat
- University Hospital Ayr, Ayr, UK
| | | | - N Boyle
- University Hospital Ayr, Ayr, UK
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Breazzano MP, Unkrich KH, Barker-Griffith AE. Clinicopathological findings in abusive head trauma: analysis of 110 infant autopsy eyes. Am J Ophthalmol 2014; 158:1146-1154.e2. [PMID: 25127695 DOI: 10.1016/j.ajo.2014.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE To investigate the histopathology in a large series of autopsy eyes from children with abusive head trauma. DESIGN Retrospective case-control series. METHODS One hundred and ten eyes from 55 autopsies examined at an academic tertiary referral center over 21 years were tabulated for histopathology: subdural hemorrhage in the optic nerve sheath, intrascleral hemorrhage, any retinal hemorrhage, ora-extended hemorrhage, cherry hemorrhage, perimacular ridge, and internal limiting membrane tear. Select tissues with cherry hemorrhage were further examined by transmission electron microscopy. RESULTS Sixty eyes were identified as "abusive head trauma" (cases), 46 as "alternative cause" (controls), and 4 as "abusive head trauma survivor". Cases were legally verified or confirmed by confession in all except 1 case. All ocular histopathologic observations from cases were similar or more frequent in infants younger than 16 months of age. When present, a cherry hemorrhage and perimacular ridge were most often found together, and only with a torn internal limiting membrane. Both abusive head trauma survivor cases demonstrated severe optic nerve atrophy and macular ganglion cell loss. CONCLUSIONS Younger infants may be even more susceptible to damage from vitreomacular traction by rotational and/or acceleration-deceleration forces. Identifying cherry hemorrhages may aid abusive head trauma diagnosis. Survivor abusive head trauma pathology demonstrates unique, irreversible macular and optic nerve damage.
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Matschke J, Büttner A, Bergmann M, Hagel C, Püschel K, Glatzel M. Encephalopathy and death in infants with abusive head trauma is due to hypoxic-ischemic injury following local brain trauma to vital brainstem centers. Int J Legal Med 2014; 129:105-14. [DOI: 10.1007/s00414-014-1060-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/30/2014] [Indexed: 12/01/2022]
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Alzahrani M, Ratelle J, Cavel O, Laberge-Malo M, Saliba I. Hearing loss in the shaken baby syndrome. Int J Pediatr Otorhinolaryngol 2014; 78:804-6. [PMID: 24646684 DOI: 10.1016/j.ijporl.2014.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate hearing in children diagnosed with shaken baby syndrome. METHODS A retrospective study conducted in a pediatric tertiary care center between 2006 and 2012. Children diagnosed with shaken baby syndrome were included for hearing evaluation by conventional audiometry, distortion product otoacoustic emissions and auditory brainstem responses. RESULTS Twenty-eight children were included (22 boys and 6 girls). The mean age of children at presentation was 8 months (range 1-26 months) and the mean delay before audiometric evaluation was 30 months (range 1-87 months). One child was diagnosed as having a moderate sensorineural hearing loss. The tympanic membrane mobility was normal (type A) for both ears in 22 children, one child had a reduced tympanic mobility in one ear, two children had a negative pressure, one child had a functional trans-tympanic tube and test was not performed in 2 patients. CONCLUSION This is the first study reporting hearing loss as a possible result of shaken baby syndrome. However, further studies with larger number of children would be preferable. We recommend hearing evaluation for these children to rule out hearing loss.
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Affiliation(s)
- Musaed Alzahrani
- Division of Otorhinolaryngology, University of Montreal, Montreal, QC, Canada
| | - Justine Ratelle
- Department of Audiology, Sainte-Justine University Hospital, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5, Canada
| | - Oren Cavel
- Division of Otorhinolaryngology, University of Montreal, Montreal, QC, Canada
| | - Marie Laberge-Malo
- Department of Pediatrics, Sainte-Justine University Hospital (CHUSJ), 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5, Canada
| | - Issam Saliba
- Division of Otorhinolaryngology Head & Neck Surgery, University of Montreal, Otology and Neurotology, Sainte-Justine University Hospital Center (CHUSJ) and University of Montreal Hospital Center (CHUM), Montreal, QC, Canada.
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15
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Dettmeyer RB. The role of histopathology in forensic practice: an overview. Forensic Sci Med Pathol 2014; 10:401-12. [PMID: 24577850 DOI: 10.1007/s12024-014-9536-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 12/19/2022]
Abstract
The role of forensic histopathology in routine practice is to establish the cause of death in particular cases. This is achieved on the basis of microscopic analysis of representative cell and tissue samples taken from the major internal organs and from abnormal findings made at autopsy. A prerequisite of this is adherence to the quality standards set out for conventional histological/cytological staining and enzyme histochemical and immunohistochemical methods. The interpretation of histological findings is performed by taking into account macroscopic autopsy findings and information on previous history. Histological analysis may prompt postmortem biochemical and chemical-toxicological investigations. The results of histological analysis need to be classified by experts in the context of the available information and the need to withstand the scrutiny of other experts.
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Affiliation(s)
- R B Dettmeyer
- Institute of Forensic Medicine, Justus-Liebig University Giessen, Frankfurter Str. 58, 35392, Giessen, Germany,
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Abbott J, Shah P. The epidemiology and etiology of pediatric ocular trauma. Surv Ophthalmol 2014; 58:476-85. [PMID: 23969021 DOI: 10.1016/j.survophthal.2012.10.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 10/11/2012] [Accepted: 10/16/2012] [Indexed: 11/25/2022]
Abstract
Eighteen million people worldwide have uniocular blindness from traumatic injury. Injuries occur disproportionally commonly in childhood. Every year a quarter of a million children present with serious ocular trauma. For the vast majority the injury is preventable. We review the international literature that identifies high-risk circumstances.
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Affiliation(s)
- Joseph Abbott
- Moorfields Eye Hospital, University College London Partners, London, UK.
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Patterns of structural head injury in children younger than 3 years: a ten-year review of 519 patients. J Trauma Acute Care Surg 2013; 74:276-81. [PMID: 23147184 DOI: 10.1097/ta.0b013e318270d82e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abusive head injury is a major contributor to morbidity and mortality in infants and toddlers, but data comparing patterns of injury in corroborated accidental trauma and confessed child abuse are scarce. METHODS This is a retrospective review of head injuries with abnormal neuroimaging in children younger than 3 years during a 10-year period in Auckland, New Zealand. Histories were assumed to be true. Results were analyzed for incongruity then compared with data on confessed abuse and corroborated accidental injury. RESULTS Five hundred nineteen cases were analyzed. Most cases were congruent with the history, and their pattern was consistent with the literature on accidental head trauma in childhood. However, a spike of subdural hemorrhage was seen in the first 6 months of life, explained neither by mechanism nor by published data on birth trauma. The age distribution of retinal hemorrhage was also inconsistent with published data on birth trauma. In infants younger than 6 months, retinal and subdural hemorrhages were associated with the absence of a history of trauma. In older children (6 months-3 years), subdural hemorrhage was more common after minor falls (<1 m, 49%) than major falls (>2 m, 20%) (p = 0.002). CONCLUSION We conclude that when a young child (particularly an infant younger than 6 months) presents with traumatic intracranial pathology and either no history of trauma or a history of a minor fall, it must be seriously considered that the history is false. LEVEL OF EVIDENCE Epidemiologic study, level III.
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Rittenhouse DW, Salvin JH, DeJong A, Zomorrodi A, Murphy SG. Infant with bilateral cataracts from non-accidental trauma. J Emerg Med 2012; 44:e133-5. [PMID: 22795473 DOI: 10.1016/j.jemermed.2012.02.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/28/2012] [Indexed: 11/25/2022]
Affiliation(s)
- David W Rittenhouse
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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19
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Reply to the letter by Dr. Langlois. Forensic Sci Med Pathol 2012. [DOI: 10.1007/s12024-011-9284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Laurent-Vannier A, Nathanson M, Quiriau F, Briand-Huchet E, Cook J, Billette de Villemeur T, Chazal J, Christophe C, Defoort-Dhellemmes S, Fortin G, Rambaud C, Raul JS, Rey-Salmon C, Sottet F, Vieux E, Vinchon M, Willinger R. A public hearing. "Shaken baby syndrome: guidelines on establishing a robust diagnosis and the procedures to be adopted by healthcare and social services staff". Scoping report. Ann Phys Rehabil Med 2011; 54:533-99. [PMID: 22118913 DOI: 10.1016/j.rehab.2011.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Laurent-Vannier
- Service de rééducation des pathologies neurologiques acquises de l'enfant, hôpitaux de Saint-Maurice, 14, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
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21
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Lantz PE, Couture DE. Fatal Acute Intracranial Injury, Subdural Hematoma, and Retinal Hemorrhages Caused by Stairway Fall*. J Forensic Sci 2011; 56:1648-53. [DOI: 10.1111/j.1556-4029.2011.01892.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Patrick E. Lantz
- Department of Pathology, Wake Forest University School of Medicine, Medical Center Blvd., Winston‐Salem, NC 27157
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest University School of Medicine, Medical Center Blvd., Winston‐Salem, NC 27157
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22
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A web-based e-learning programme for training external post-mortem examination in curricular medical education. Int J Legal Med 2011; 125:857-61. [PMID: 21901359 DOI: 10.1007/s00414-011-0613-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 08/12/2011] [Indexed: 10/17/2022]
Abstract
In Germany, the external post-mortem examination is considered a medical duty and may be performed by any licensed physician. Concerning legal medicine as a curricular subject in teaching medical students, the external post-mortem examination is regarded a core area. At the University of Müenster, 15 virtual cases of death have been developed by using the web-based Inmedea Simulator. The programme allows performing all relevant steps in executing a complete external post-mortem examination. A particular importance was attached to the aspect of training users in approaching the subject in a systematic way to interpret significant forensic findings correctly and to comprehend their medico-legal implications. The programme was used for the first time in the academic term of 2010/2011. The overall reception of the programme by the medical students resulted to be positive in a first evaluation.
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Abstract
Retinal hemorrhage is a cardinal manifestation of abusive head trauma. Over the 30 years since the recognition of this association, multiple streams of research, including clinical, postmortem, animal, mechanical, and finite element studies, have created a robust understanding of the clinical features, diagnostic importance, differential diagnosis, and pathophysiology of this finding. The importance of describing the hemorrhages adequately is paramount in ensuring accurate and complete differential diagnosis. Challenges remain in developing models that adequately replicate the forces required to cause retinal hemorrhage in children. Although questions, such as the effect of increased intracranial pressure, hypoxia, and impact, are still raised (particularly in court), clinicians can confidently rely on a large and solid evidence base when assessing the implications of retinal hemorrhage in children with concern of possible child abuse.
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Affiliation(s)
- Alex V Levin
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Institute, Suite 1210, 840 Walnut St, Philadelphia, PA 19107, USA.
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24
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Wygnanski-Jaffe T, Morad Y, Levin AV. Pathology of retinal hemorrhage in abusive head trauma. Forensic Sci Med Pathol 2009; 5:291-7. [PMID: 20024631 DOI: 10.1007/s12024-009-9134-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2009] [Indexed: 12/01/2022]
Abstract
Abusive head injury, characterized by repeated acceleration-deceleration forces, is associated with retinal hemorrhages as demonstrated in many clinical and postmortem studies. The theory that vitreoretinal traction is the major factor in the pathogenesis of retinal hemorrhages is presently the most widely accepted explanation based on different lines of research. Postmortem examination of the eye and orbital structures is essential for recognizing abusive head injury and also for identifying other possible medical conditions which can cause retinal hemorrhage.
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Matschke J, Voss J, Obi N, Görndt J, Sperhake JP, Püschel K, Glatzel M. Nonaccidental head injury is the most common cause of subdural bleeding in infants <1 year of age. Pediatrics 2009; 124:1587-94. [PMID: 19948629 DOI: 10.1542/peds.2008-3734] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Subdural bleeding (SDB) in infants is considered an essential symptom of nonaccidental head injury (NAHI). Recently, this view has been challenged by the "unified hypothesis," which claims that SDB in infants is related to hypoxia and brain swelling rather than to traumatic shearing of bridging veins. We analyzed a large series of infants' autopsies for the presence and causes of SDB, which should be a common event according to the unified hypothesis. METHODS Autopsy, clinical, and legal information for infants <1 year of age from a single institution over 50 years were analyzed regarding cause of death, presence, morphology, and cause of SDB, and brain weight. RESULTS From a total of 16 661 autopsies during the study period, 715 (4.3%) involved infants <1 year of age. Fifty (7.0%) of those had SDB. NAHI was identified in 17 patients. The most common cause of SDB was trauma (15 cases [30.0%]), with NAHI accounting for 14 cases. SDB was present in 82.4% of patients with NAHI but only 5.2% of infants with other causes of death. Four patients (8.0%) had unexplained SDB with no discernible cause of bleeding. Statistical analysis did not reveal any correlation between the presence of SDB and brain weight. CONCLUSIONS In the study population, unexplained SDB in infants was an extreme rarity. Moreover, a correlation between brain swelling and the presence of SDB could not be drawn. Our data argue strongly against the unified hypothesis and strengthen the association between SDB and NAHI in infancy.
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Affiliation(s)
- Jakob Matschke
- Forensic Neuropathology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
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Fracasso T, Karger B, Pfeiffer H, Sauerland C, Schmeling A. Immunohistochemical identification of prevalent right ventricular ischemia causing right heart failure in cases of pulmonary fat embolism. Int J Legal Med 2009; 124:537-42. [PMID: 19894059 DOI: 10.1007/s00414-009-0382-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 09/30/2009] [Indexed: 11/24/2022]
Abstract
Pulmonary fat embolism is a life-threatening event that may result to potentially determining right ventricular failure. Even if the pathophysiology of this phenomenon has been widely investigated, no immunohistochemical demonstration of right ventricular failure following pulmonary fat embolism has been reported till now. We performed an immunohistochemical investigation with the markers fibronectin and C5b-9 in 21 cases of polytrauma with bone fractures (study group-nine females and 12 males; mean age 64.6 years) compared to a control group of 21 forensic cases with various causes of death (nine females and 12 males; mean age 68.6 years). In each case at least one tissue slide from both cardiac ventricles (free wall of the right ventricle, anterior and/or posterior wall of the left ventricle) was available. The reactions were semi-quantitatively classified, and the two groups were compared. In the study group, the occurrence of ischemic changes at the right ventricle was significantly higher than in controls. The determining aspect, however, seems to be the prevalent ischemic lesion at the right ventricle compared to the left one. This may indicate the primary involvement of the right ventricle, thus, demonstrating a right ventricular failure.
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Affiliation(s)
- Tony Fracasso
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany.
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Matschke J, Herrmann B, Sperhake J, Körber F, Bajanowski T, Glatzel M. Shaken baby syndrome: a common variant of non-accidental head injury in infants. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:211-7. [PMID: 19471629 PMCID: PMC2680569 DOI: 10.3238/arztebl.2009.0211] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 01/02/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent cases of child abuse reported in the media have underlined the importance of unambiguous diagnosis and appropriate action. Failure to recognize abuse may have severe consequences. Abuse of infants often leaves few external signs of injury and therefore merits special diligence, especially in the case of non-accidental head injury, which has high morbidity and mortality. METHODS Selective literature review including an overview over national and international recommendations. RESULTS Shaken baby syndrome is a common manifestation of non-accidental head injury in infancy. In Germany, there are an estimated 100 to 200 cases annually. The characteristic findings are diffuse encephalopathy and subdural and retinal hemorrhage in the absence of an adequate explanation. The mortality can be as high as 30%, and up to 70% of survivors suffer long-term impairment. Assessment of suspected child abuse requires meticulous documentation in order to preserve evidence as well as radiological, ophthalmological, laboratory, and forensic investigations. CONCLUSIONS The correct diagnosis of shaken baby syndrome requires understanding of the underlying pathophysiology. Assessment of suspected child abuse necessitates painstaking clinical examination with careful documentation of the findings. A multidisciplinary approach is indicated. Continuation, expansion, and evaluation of existing preventive measures in Germany is required.
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Affiliation(s)
- Jakob Matschke
- Forensische Neuropathologie, Institut für Neuropathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
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