Thursday, January 13, 2011

Retinal changes in inflicted pediatric head trauma

The illustrious Peter Cummings, MD recently contributed an excellent post to the Cambridge University Press medical blog on the topic inflicted pediatric head trauma.  In particular, Dr. Cummings discusses the presence of retinal hemorrhage and retinal hemorrhage as evidence for pediatric head trauma. Whether or not the trauma had been intentionally inflicted depends, of course, on the history provided by witnesses and law there are no pathognomonic findings. But, as Dr. Cummings says in his post: "I treat every pediatric case as though it is a homicide until I can prove to myself that it is not."

Retinal fold with hemorrhage
Given the near ubiquity of artefactual retinal folds in extracted eye specimens, I asked Dr. Cummings whether there is a role for postmortem funduscopic examination. He responded that he has had some success with this technique, but postmortem corneal clouding often makes funduscopic exams impossible.
Dr. Cummings is the director of forensic neuropathology at the Office of the Chief Medical Examiner in Boston, Massachusetts. He is also first editor of Atlas of Forensic Histopathology, which has just been released by Cambridge University Press.


Anonymous said...

If Dr Cummings (for whom I have great respect) has cases in which there were witnessed febrile seizures or other "medical" events without any possibility of trauma, leading to death with diffuse extensive retinal hemorrhages at autopsy in infants, then I hope he has published these in peer-reviewed journal articles and can provide us with the references. I have not seen retinal hemorrhages (and I look in every infant autopsy) in cases with brain tumors, brain infections, and other causes of increased intracranial pressure. So I would be very interested, as I am sure many others would be, for documentation of Dr Cumming's experience. Unfortunately a blog entry, or even something published in a book, isn't good enough.

Brian E. Moore, MD, MEd said...

To Anonymous:
Do you look for hemorrohages and/or folds in the retina using a funduscope? Or just microscopically on the exenterated eye?

Forensic Pathology Blog said...

Excellent response! Obviously, the blog is a marketing thing with Cambridge U Press. These cases came to me after the textbook was finished, so they are sort of bonus material! I am astonished by these cases and I can not understate the importance of publishing them in a top-tier peer reviewed journal. I am in the process of writing them up and hope to submit them in the next few weeks. Wonderful point made by anonymous!
PS: My early hypothesis is that these injures can be seen with very severe, very rapid increases in ICP which may explain why I have also never seen them in the situations described by Anonymous.

Forensic Pathology Blog said...

I meant overstate, I'm on vacation!

worried parent said...

Thanks so much for this post! I've been wondering about this a lot lately, and this answered all of my questions. Keep up the great work here!

Anonymous said...

the details are very informative and my interests are the side effects of the trauma. Maybe I just need to look for relevant information on the site.