Retroocular and Subdural Hemorrhage or Hemosiderin Deposits in Pediatric Autopsies.
The presence of hemosiderin in the optic nerve sheath and/or retina is sometimes used to estimate the timing of injury in infants or children with suspected non-accidental head trauma. To determine the prevalence of hemosiderin in deaths not associated with trauma, we performed a prospective study of retroocular orbital tissue, cranial convexity, and cervical spinal cord dura mater in infants and children <2.5 years age. In 53 cases of non-traumatic death, approximately 70% had blood or hemosiderin within the orbital fat, ocular muscles, and parasagittal cranial and/or cervical spinal subdural compartment. This bleeding is likely a consequence of the birth process. None had evidence of hemorrhage within the optic nerve sheath. Premature birth was less likely associated with orbital tissue hemorrhage. Caesarean section birth (mainly nonelective) was not associated with lower prevalence. Residual hemosiderin was identifiable up to 36 weeks postnatal age, suggesting gradual disappearance after birth. Cardiopulmonary resuscitation (performed in the majority of cases) was not associated with acute hemorrhage. In 9 traumatic deaths, 6 had blood and/or hemosiderin within the optic nerve sheath. Knowledge of the potential presence and resolution of hemosiderin in these locations is important for medicolegal interpretation of childhood deaths associated with head or brain injury.
Department of Pathology, University of Manitoba, Winnipeg, Canada.|Diagnostic Services Manitoba, Manitoba, Winnipeg, Canada.|Children's Hospital Research Institute of Manitoba, Manitoba, Winnipeg, Canada
Marc R
MR
Del Bigio
Department of Pathology, University of Manitoba, Winnipeg, Canada.|Diagnostic Services Manitoba, Manitoba, Winnipeg, Canada.
Susan M
SM
Phillips
D000273:Adipose Tissue / Q000378:metabolism / Q000473:pathology; D001344:Autopsy / Q000379:methods*; D002585:Cesarean Section; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000378:metabolism* / Q000473:pathology*; D005260:Female; D006408:Hematoma, Subdural / Q000378:metabolism*; D006485:Hemosiderin / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009801:Oculomotor Muscles / Q000378:metabolism / Q000473:pathology; D009900:Optic Nerve / Q000378:metabolism*; D009915:Orbit / Q000473:pathology; D011446:Prospective Studies; D012160:Retina / Q000378:metabolism*; D038642:Shaken Baby Syndrome / Q000378:metabolism / Q000473:pathology
D006485:Hemosiderin
Autopsy; Child Abuse; Forensic Pathology; Head Trauma; Hemorrhage; Optic Nerve; Shaken Baby