Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury

Abstract

Retinal and optic nerve sheath hemorrhages are an essential part of the various forms of inflicted neurotrauma in infants, especially in its most common variant, the shaken baby syndrome (SBS). Clinically, ophthalmologists play an important part for the diagnosis and further management of patients with SBS. For the forensic pathologist, a thorough understanding of the basic principles behind the morphological phenomena commonly encountered in the orbita is required. This review summarizes the present knowledge of ocular pathology in inflicted infantile neurotrauma, focusing strongly on SBS. Furthermore, a review of the most recent literature on the subject is given.

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“…In 70-90% of the patients, unilateral or bilateral retinal bleedings are present (16,23,38,41,42,43). In a meta-analysis, it was found that retinal bleedings which developed related to non-accidental head injury were typically diffuse, symmetrical on both sides and localized in many layers posteriorly or adjacent to the ora serrata.…”

“…Since ophthalmological findings are important in the diagnosis the examination should be performed by experienced specialists (pediatric ophthalmologist, pediatric neurologist) using appropriate devices and dilating the pupils (41,42,43). It has been reported that a false negative result can be obtained with a rate of 13% in ophthalmological examination performed by other clinicians (18).…”

Unique Pre-ß Amyloid Precursor Protein (APP-A4) Observations in Ocular Tissues from Suspected Abusive Head Trauma Victims

“…Ocular injury, especially retinal hemorrhages, have been documented in 40-75% of reported AHT cases [3][4][5]. Other features of fatal cases often include somnolence on admission to emergency rooms, subarachnoid and subdural hemorrhage, skull and other fractures, apnea and hypoxia related to severe intracranial pressure (ICP) elevation inhibiting blood flow to the brain resulting in severe brain edema with fontanelle widening.…”

Subdural Hygromas in Abusive Head Trauma: Pathogenesis, Diagnosis, and Forensic Implications

“…In some cases, metaphyseal fractures, rib fractures, or small hematomas on arms or thorax may be encountered. [18][19][20][21][22] The caregiver's explanation provided for the injuries is frequently inadequate or inconsistent. 9,18 The diagnosis and dating of AHT in living infants predominantly relies on neuroimaging by means of CT and/or MR imaging.…”