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Persistent Retinal Iron in Abusive Head Trauma
Babette Bais1, Wouter A Karst1, Bela Kubat1
1Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands.
Insights
Retinal hemosiderin deposition, a sign of bleeding in abusive head trauma (AHT), can persist for over 32 months, challenging the 6-8 week assumption. This finding impacts diagnosing AHT in infants.
Area of Science:
- Ophthalmology
- Pediatric Pathology
- Forensic Medicine
Background:
- Retinal hemosiderin deposition is a histological marker for retinal hemorrhages.
- Its persistence is typically assumed to be short-term, usually within 6-8 weeks post-hemorrhage in abusive head trauma (AHT).
- Accurate dating of retinal hemorrhages is crucial in AHT investigations.
Observation:
- A 5-month-old infant presented with signs of AHT, including subdural hematomas and retinal hemorrhages.
- At age 3, the patient experienced a femur fracture and later died.
- Ophthalmopathological examination revealed retinal and optic nerve atrophy with bilateral hemosiderin deposition.
Findings:
- The infant exhibited bilateral retinal hemosiderin deposition 32 months after the initial AHT event.
- This case demonstrates hemosiderin deposition persisting significantly longer than the commonly accepted 6-8 week timeframe.
- The findings challenge the established timeline for hemosiderin resolution in AHT.
Implications:
- The persistence of retinal hemosiderin deposition has significant implications for forensic investigations and the diagnosis of AHT.
- This case highlights the need to reconsider the temporal interpretation of hemosiderin in AHT.
- It suggests that hemosiderin deposition may be a more enduring indicator of past retinal hemorrhages than previously thought.
Abstract:
Retinal hemosiderin deposition is a histologic indicator of sustained hemorrhage but cannot be used to precisely estimate the elapsed time since an episode of trauma. A 5-month-old male infant was admitted to hospital after acute deterioration. Examination revealed encephalopathy, subdural hematomas, and retinal hemorrhages consistent with abusive head trauma (AHT). At the age of 3, he was readmitted to hospital with spontaneous osteopenic fracture of the right femur. The patient deteriorated and died after unsuccessful resuscitation. Ophthalmopathological investigation showed atrophy of the retina and optic nerve and hemosiderin deposition in both eyes. Retinal hemosiderin deposition is currently generally assumed to disappear within 6-8 weeks after the occurrence of hemorrhage in AHT. This case report describes an infant with bilateral retinal hemosiderin depositions due to hemorrhages sustained from AHT occurring 32 months prior to death. Implications of this finding for the interpretation of retinal hemosiderin depositions in AHT are discussed.
