title: The optic nerve sheath hemorrhage is a non-specific finding in cases of suspected child abuse.
abstract: In young infants, the triad consisting of acute encephalopathy, retinal hemorrhages, and a subdural hematoma is a nonspecific finding. It has traumatic and non-traumatic etiologies. The triad may be found among a vast spectrum of natural diseases. Optic nerve sheath hemorrhage in infants is typically detected at autopsy. It is a nonspecific finding that can be found in traumatic and non-traumatic etiologies. Neither the triad nor the ONSH are pathognomonic for an abusive head injury. Opposite to the triad, the spectrum of non-traumatic etiologies of ONSH is limited. In infants ONSH rarely occurs in spontaneous subarachnoidal hemorrhage or in infectious conditions. Our results show that the clinical significance of the optic nerve sheath hemorrhage in the forensic work-up of fatal cases of alleged abusive head injury is its limited differential diagnosis. Only after careful differential diagnosis ONSH may contribute to the diagnosis of AHT. However, the main limitation of our study is the sampling bias, as the eyes are usually removed when abusive head trauma is suspected.
authors.affiliation: Department of Forensic Medicine and Pathology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium; Community Hospital Aalst, Merestraat 80, B-9300 Aalst, Belgium; Decanaat University of Gent, De pintelaan, 185, 9000 Gent, Belgium.
authors.forename: Marc De
authors.initials: MD
authors.lastname: Leeuw
authors.affiliation: Department of Forensic Medicine and Pathology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. Electronic address: ebeuls@neuroexpertise.be.
authors.forename: Emile
authors.initials: E
authors.lastname: Beuls
authors.affiliation: Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp Wilrijkstraat 10, B-2650 Edegem, Belgium.
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Jorens
authors.affiliation: Department of Radiology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Parizel
authors.affiliation: Department of Forensic Medicine and Pathology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
authors.forename: Werner
authors.initials: W
authors.lastname: Jacobs
mesh_terms: D001930:Brain Injuries / Q000209:etiology / Q000473:pathology; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D049429:Forensic Pathology; D006408:Hematoma, Subdural / Q000209:etiology / Q000473:pathology; D006470:Hemorrhage / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D009900:Optic Nerve / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000209:etiology / Q000473:pathology*; D012166:Retinal Hemorrhage / Q000209:etiology / Q000473:pathology
keywords: Abusive head trauma; Optic nerve sheath hemorrhage; Postmortem examination; Retinal hemorrhage