Finite element model of ocular injury in abusive head trauma

Rangarajan, N.; Kamalakkannan, Sarath Babu; Hasija, Vikas; Shams, T.; Jenny, Carole; Serbanescu, Irina; Ho, Jamie; Rusinek, Matthew; Levin, Alex V.

doi:10.1016/j.jaapos.2008.11.006

Cited by 73 publications

(39 citation statements)

References 21 publications

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“…Injury may preferentially occur at tethering locations, such as the optic nerve-globe junction and apex of the orbit. This mechanism might explain optic nerve sheath hemorrhage occurring predominately anteriorly along the nerve, which suggests that blood did not arise from communication within the intracranial space [23]. Optic nerve atrophy often seen in survivors of abusive head trauma may also be best explained by direct optic nerve injury within the orbit.…”

Section: Pathogenesis Of Retinal Hemorrhage In Abusive Head Traumamentioning

confidence: 99%

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

Binenbaum

Forbes

2014

Pediatr Radiol

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This review presents an up-to-date overview of ocular injuries resulting from child abuse, with a spotlight on abusive head trauma. Retinal hemorrhage is a principle finding of inflicted head trauma. The specific pattern of hemorrhages holds valuable diagnostic information, which can help to guide multidisciplinary assessments of the likelihood of abuse. Indirect ophthalmoscopy through dilated pupils by an ophthalmologist is necessary for adequate examination and documentation of retinal findings. Initial pediatrician evaluation of the eye and indications for ophthalmological consultation are reviewed. Focus is then placed upon understanding retinal hemorrhage patterns, their diagnostic significance and likely pathophysiological mechanisms. The differential diagnosis of retinal hemorrhage in young children is discussed, highlighting key distinctions among retinal hemorrhage patterns, severity and frequencies, as well as other ocular findings. The most common cause of retinal hemorrhage in an infant is trauma, and most other causes can be identified by considering the hemorrhage pattern, ocular or systemic signs and the results of laboratory and imaging tests, when indicated.

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Section: Pathogenesis Of Retinal Hemorrhage In Abusive Head Traumamentioning

confidence: 99%

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

Binenbaum

Forbes

2014

Pediatr Radiol

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“…First, there has been a continued and dramatic increase in the evidence supporting the diagnostic specificity of severe hemorrhagic retinopathy as an indicator of AHT, in particular, severe repeated acceleration-deceleration with or without blunt head impact. Extensive literature worldwide, including clinical studies, 7 animal models, 22 and computer modeling, 23,24 well beyond the scope of this report, support this theory. It seems that vitreoretinal traction and orbital injury sustained during the unique repetitive accelerationdeceleration mechanism that distinguishes this form of abuse from singleimpact trauma is the critical factor in causing retinal hemorrhage.…”

Section: Statement Of the Problemmentioning

confidence: 53%

The Eye Examination in the Evaluation of Child Abuse

Christian¹,

Levin²,

Neglect³

2010

Pediatrics

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Retinal hemorrhage is an important indicator of possible abusive head trauma, but it is also found in a number of other conditions. Distinguishing the type, number, and pattern of retinal hemorrhages may be helpful in establishing a differential diagnosis. Identification of ocular abnormalities requires a full retinal examination by an ophthalmologist using indirect ophthalmoscopy through a pupil that has been pharmacologically dilated. At autopsy, removal of the eyes and orbital tissues may also reveal abnormalities not discovered before death. In previously well young children who experience unexpected apparent life-threatening events with no obvious cause, children with head trauma that results in significant intracranial hemorrhage and brain injury, victims of abusive head trauma, and children with unexplained death, premortem clinical eye examination and postmortem examination of the eyes and orbits may be helpful in detecting abnormalities that can help establish the underlying etiology.

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“…Other animal models have also demonstrated hemorrhages in the areas of vitreoretinal attachment [36]. Finite element analysis computer modeling predicts maximal shear forces at areas of vitreoretinal traction [37,38].…”

Section: Pathogenesis Of Ocular Findingsmentioning

confidence: 99%

Pathology of retinal hemorrhage in abusive head trauma

Wygnanski–Jaffe

Morad

Levin

2009

Forensic Sci Med Pathol

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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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Finite element model of ocular injury in abusive head trauma

Cited by 73 publications

References 21 publications

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

The Eye Examination in the Evaluation of Child Abuse

Pathology of retinal hemorrhage in abusive head trauma

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