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Are peripapillary intrascleral hemorrhages pathognomonic for abusive head trauma?

Candace H Schoppe1, Patrick E Lantz

  • 1Office of Chief Medical Examiner, 520 1st Avenue, New York, NY 10016, USA. CSchoppe@ocme.nyc.edu

Journal of Forensic Sciences
|May 16, 2012
PubMed

Insights

Accidental severe head trauma in neonates can cause retinal hemorrhages (RHs) and peripapillary intrascleral hemorrhages. These findings, previously thought unique to abusive head trauma, highlight the need for careful differential diagnosis.

Area of Science:

  • Ophthalmology
  • Pediatric Pathology
  • Forensic Medicine

Background:

  • Retinal hemorrhages (RHs) are often investigated in cases of suspected child abuse.
  • Peripapillary intrascleral hemorrhages (PIH) have been considered pathognomonic for abusive head trauma (AHT).
  • Current guidelines suggest avoiding postmortem eye removal in cases of clear accidental death.

Observation:

  • Two neonates experienced severe accidental in utero head injuries.
  • Autopsies revealed extensive RHs, optic nerve sheath hemorrhages, and PIH in both neonates.
  • Neither infant had a documented clinical fundal examination prior to death.

Findings:

  • The presence of RHs and PIH in neonates with accidental head trauma challenges their exclusive association with AHT.
  • Accidental severe head injuries, even in utero, can mimic findings typically attributed to abuse.
  • This underscores the importance of considering non-abusive etiologies for these ocular findings.

Implications:

  • Findings necessitate a broader differential diagnosis for RHs and PIH in neonates.
  • Rethinking diagnostic criteria for AHT may be required.
  • Careful clinical evaluation and consideration of accidental trauma are crucial in interpreting these pediatric autopsy findings.

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