Clinicopathological findings in abusive head trauma: analysis of 110 infant autopsy eyes

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 limitingmembranetear.Selecttissues withcherryhemorrhage 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, irreversiblemacularandoptic nervedamage. (Am JOphthalmol2014;158:1146‐1154. 2014TheAuthors. PublishedbyElsevierInc.Allrightsreserved.Thisisanopen access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/3.0/).)