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Technical communication: rationale and technique for examination of nervous system in suspected infant victims of
Alexander R Judkins1, Ian G Hood, Haresh G Mirchandani
1Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. judkins@mail.med.upenn.edu
Insights
Fatal child abuse often involves brain and spinal cord injuries in victims under 2 years old. A standardized postmortem examination technique, focusing on the cervicomedullary junction, helps identify shaking injuries.
Area of Science:
- Forensic Pathology
- Pediatric Pathology
- Neuropathology
Background:
- Fatal child abuse disproportionately affects children under 2 years.
- Typical injuries involve the brain and spinal cord, crucial for determining cause of death.
- Existing guidelines for central nervous system examination in these cases are limited.
Purpose of the Study:
- To outline a standardized postmortem dissection procedure for the central nervous system.
- To emphasize the importance of the cervicomedullary junction and spinal cord in identifying shaking injuries.
- To provide a histologic sectioning protocol for documenting microscopic changes.
Main Methods:
- A specific postmortem dissection technique for the brain and spinal cord is described.
- The technique focuses on preserving the cervicomedullary junction anatomy.
- A standard series of histologic sections is recommended.
Main Results:
- The described technique optimally documents central nervous system injuries in child abuse cases.
- Changes in the cervicomedullary junction and spinal cord are highlighted as key indicators of shaking injury.
- Integration with eye and optic nerve examination enhances identification of shaking-related trauma.
Conclusions:
- A standardized postmortem examination protocol, including specific dissection and histology, is essential for documenting child abuse injuries.
- The cervicomedullary junction and spinal cord are critical areas for identifying shaking injuries.
- This systematic approach improves the accuracy of determining the cause and manner of death in fatal child abuse cases.
Abstract:
Most victims of fatal child abuse are under the age of 2 years and have a fairly typical pattern of injuries that involve the brain and spinal cord. Documenting these injuries in a systematic fashion is of paramount importance in establishing the cause and manner of death. Although the importance of recognizing these injuries is widely understood, there are few guidelines for the optimal examination of the central nervous system to document these changes. A standard procedure for postmortem dissection of the brain and spinal cord that preserves the anatomy of the cervicomedullary junction is outlined. Changes in the cervicomedullary junction and spinal cord are an underappreciated marker for shaking injury in children. This technique, along with examination of the eyes and optic nerves, will optimally identify the injuries associated with shaking injuries. A standard series of histologic sections are also outlined to document the corresponding microscopic changes.
