TY - JOUR
T1 - Clinicopathological findings in abusive head trauma
T2 - Analysis of 110 infant autopsy eyes
AU - Breazzano, Mark P.
AU - Unkrich, Kelly Hodson
AU - Barker-Griffith, Ann E.
N1 - Publisher Copyright:
© 2014 The Authors.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84912098468&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84912098468&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2014.08.011
DO - 10.1016/j.ajo.2014.08.011
M3 - Article
C2 - 25127695
AN - SCOPUS:84912098468
SN - 0002-9394
VL - 158
SP - 1146-1154.e2
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 6
ER -