Four intracranial injury cases with peripapillary scleral hemorrhage—Reconsidering the mechanism of hemorrhage

Oshima, Toru; Yoshikawa, Hiroshi; Koda, Yoshiro; Ohtani, Maki; Tsukamoto, Shoko; Mimasaka, Sohtaro

doi:10.1016/j.legalmed.2017.06.001

Cited by 2 publications

(6 citation statements)

References 14 publications

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“…Regarding ONSH, in fact, Puanglumyai et al [71] have illustrated how this examination allows for an accurate visualization of extravascular erythrocytes in the epidural, subdural, and subarachnoid spaces as well as in the nerve fibers, allowing for an agile confirmation of autopsy findings or, alternatively, a new diagnosis in case of poor macroscopic evidence of hemorrhages. Oshima et al [93], instead, used the same method for the detection of PSH, highlighting how these occurred precisely in correspondence with the Zinn-Haller arterial ring, supporting the pathogenetic mechanism proposed by the same author. Indeed, as noted by Del Bigio and Phillips [94], a critical aspect of such investigations is related to the following factors:…”

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confidence: 71%

“…Subsequently, 123 articles were excluded because they did not meet the inclusion criteria. Finally, 16 articles were included for qualitative analysis [71,78,[87][88][89][90][91][92][93][94][95][96][97][98][99][100] (Figure 1).…”

Section: Study Selectionmentioning

confidence: 99%

“…Despite two articles [87,88] being written in German, all of the considered papers presented abstracts written in English. From a structural point of view, six of them consist of case reports or case series associated with a brief literature review [71,87,88,[91][92][93]; two articles consist of reviews of the scientific knowledge available at the time of writing [78,98]; one is a technical note of the author [90]; and the seven remaining are original articles, all statistically validated [89,[94][95][96][97]99,100].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…According to Yusuf et al [93], the Optos P200MA Scanning Laser Ophthalmoscope (SLO) represents a valid alternative to the RetCam, as it allows obtaining a 200 • field of view with a single shot, without the need for eye contact or sedation. Consequently, this tool reduces the risk of stimulating the ocular-cardiac reflex in subjects already affected by intracranial hypertension; furthermore, confocal optics allow the visualization of lesions detected on the retinal plane, including macular schisis and pre-macular hemorrhages.…”

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confidence: 99%

“…Regarding peripapillary scleral hemorrhages (PSH), already known in a forensic context to be related to AHT [104,105], it has long been believed to derive from the typical acceleration/deceleration forces of shaking applied to the sclero-papillary junction with consequent traction of the intrascleral vessels of the Zinn's arterial ring [106]. However, the experience of Oshima et al [93] has allowed for a new hypothesis to be put forward based on the assumption that bleeding results from the Zinn-Haller arterial ring directly associated with traction of the ON. Consequently, the same author proposed the finding of PSH as an indicator of acceleration trauma stronger than RH.…”

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confidence: 99%

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New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review

et al. 2023

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(1) Background: Head trauma represents the first cause of death in abused children, but diagnostic knowledge is still limited. The characteristic findings of abusive head trauma (AHT) are retinal hemorrhages (RH) and additional ocular findings, including optic nerve hemorrhages (ONH). However, etiological diagnosis must be cautious. (2) Methods: The Preferred Reporting Items for Systematic Review (PRISMA) standards were employed, and the research focus was the current gold standard in the diagnosis and timing of abusive RH. (3) Results: Sixteen articles were included for qualitative synthesis. The importance of an early instrumental ophthalmological assessment emerged in subjects with a high suspicion of AHT, with attention to the localization, laterality, and morphology of the findings. Sometimes it is possible to observe the fundus even in deceased subjects, but the current techniques of choice consist of Magnetic Resonance Imaging and Computed Tomography, also useful for the timing of the lesion, the autopsy, and the histological investigation, especially if performed with the use of immunohistochemical reactants against erythrocytes, leukocytes, and ischemic nerve cells. (4) Conclusions: The present review has made it possible to build an operational framework for the diagnosis and timing of cases of abusive retinal damage, but further research in the field is needed.

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confidence: 71%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review

et al. 2023

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A Case of Personal Identification Via Postmortem Computed Tomography Confirmation of Aphakic Eyes

Oshima

Yoshikawa

Yoshitomi

et al. 2020

Am J Forensic Med Pathol

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Postmortem computed tomography (PMCT) is used commonly in forensic medicine. Postmortem computed tomography of the head provides information on the eyes and orbits and may reveal intraocular abnormalities. We present a case in which the identity of a deceased man was confirmed by the presence of aphakic eyes detected on PMCT. A decomposed body was found in a house and suspected to be a man in his 40s who lived alone. Autopsy identified pontine hemorrhage as the cause of death. Although signs of previous dental treatment were evident, the storage period of the householder's dental records had expired. He had no family members to provide DNA for a comparative DNA analysis. Postmortem computed tomography before autopsy revealed aphakia (ie, the absence of eye lenses) suggestive of previous ocular surgery. His medical records revealed that he had undergone ocular surgery for secondary glaucoma due to uveitis, which had resulted in artificial aphakia. Peripheral iridectomy scars fully matched the findings in his medical records, thus identifying the body. The unusual finding of artificial aphakia in a man in his 40s facilitated the personal identification in this case. In conclusion, PMCT provides additional information, and the correct interpretation of intraocular PMCT findings by forensic pathologists is crucial.

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Four intracranial injury cases with peripapillary scleral hemorrhage—Reconsidering the mechanism of hemorrhage

Cited by 2 publications

References 14 publications

New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review

New Insights into the Diagnosis and Age Determination of Retinal Hemorrhages from Abusive Head Trauma: A Systematic Review

A Case of Personal Identification Via Postmortem Computed Tomography Confirmation of Aphakic Eyes

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