title: Persistent Retinal Iron in Abusive Head Trauma.
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.
authors: Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands.
authors: Babette
authors: B
authors: Bais
authors: Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands.
authors: Wouter A
authors: WA
authors: Karst
authors: Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands.
authors: Bela
authors: B
authors: Kubat
authors: Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors: Robert M
authors: RM
authors: Verdijk
mesh_terms: D002649:Child Abuse; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D006408:Hematoma, Subdural; D006801:Humans; D007223:Infant; D007501:Iron / Q000032:analysis*; D008297:Male; D012160:Retina / Q000737:chemistry*; D012166:Retinal Hemorrhage
chemical_list: D007501:Iron
keywords: abusive head trauma; child abuse; forensic science; hemosiderin; long-term survivor; ophthalmic pathology; pathology; retinal hemorrhages; shaken baby syndrome