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Multicystic encephalopathy in abusive head trauma
Clinical Neuropathology
|April 15, 2014
Summary
Determining abusive head trauma (AHT) in infants is challenging. Brain damage patterns in multicystic encephalopathy do not reliably indicate injury timing, but AHT should be considered when no medical cause is found.
Area of Science:
- Pediatric neuropathology
- Forensic medicine
- Infant brain injury
Background:
- Abusive head trauma (AHT) diagnosis in infants is difficult, particularly with delayed presentation.
- Infants surviving acute AHT may develop multicystic encephalopathy, with age-dependent brain changes potentially indicating injury timing.
- Understanding these patterns is crucial for identifying perpetrators and aiding legal proceedings.
Purpose of the Study:
- To analyze brain damage patterns in infants with AHT-induced multicystic encephalopathy.
- To determine if cystic changes correlate with age at trauma or survival period.
- To investigate the etiological mechanisms and implications for diagnosing AHT.
Main Methods:
- Retrospective analysis of nine archival cases of trauma-induced multicystic encephalopathy (2005-2011).
- Histological evaluation of hematoxylin-eosin-stained whole-hemisphere and cerebellar slides.
- Assessment of topographic distribution of macroscopic and microscopic brain changes.
Main Results:
- Cerebral hemispheres were more affected than the cerebellum.
- Cystic change magnitude did not correlate with age at trauma or survival period.
- Asymmetrical cerebral hemisphere involvement was noted in all cases, pronounced in three; injury patterns indicated ischemia and hypoperfusion.
Conclusions:
- Brain damage magnitude and distribution do not aid in estimating the time of abusive head trauma.
- Ischemia and hypoperfusion are primary mechanisms of brain injury in these cases.
- Multicystic encephalopathy without a clear medical explanation warrants consideration of remote abusive head trauma.
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