Gleckman A M, Evans R J, Bell M D, Smith T W
Office of the Chief Medical Examiner of Massachusetts, Boston, Massachusetts, USA.
Arch Pathol Lab Med. 2000 Feb;124(2):251-6. doi: 10.5858/2000-124-0251-ONDISB.
Rapid acceleration-deceleration of an infant's head during intentional shaking should in theory exert stretch or shear forces upon the optic nerves sufficient to cause axonal injury. beta-Amyloid precursor protein (beta-APP) immunohistochemistry recently has been shown to be a highly effective method for identifying diffuse axonal injury in the brains of infants with shaken baby syndrome. In this study, we investigated the utility of beta-APP in identifying optic nerve damage in infants who have sustained fatal whiplash shaking.
beta-Amyloid precursor protein immunohistochemistry was performed on formalin-fixed, paraffin-embedded sections of eyes (including optic disc and distal optic nerve) from infants less than 1 year of age with shaken baby syndrome (5 cases), combined shaken baby syndrome/blunt head trauma (3 cases), and "pure" blunt head trauma (1 case). Nontraumatic control cases included infants who died of suffocation (1 case), sudden infant death syndrome (1 case), and positional asphyxia (1 case) and an enucleation from a child with a retinoblastoma (1 case). Matched hematoxylin-eosin-and neurofilament-stained sections were used for comparison.
Three of the 5 shaken baby cases and all 3 combined shaken baby/blunt head trauma cases had optic nerve axonal injury identified by the presence of strongly beta-APP-immunoreactive beaded or swollen axonal segments. Axonal injury could not be detected in the corresponding hematoxylin-eosin-or neurofilament-stained sections. Optic nerve axonal injury was not seen in the case involving pure blunt head trauma or in the nontraumatic control cases.
Optic nerve axonal injury is a prominent feature of intentional fatal whiplash head trauma in infants less than 1 year of age. beta-Amyloid protein precursor immunohistochemistry appears to be the most effective method for demonstrating axonal damage in the optic nerve.
在故意摇晃婴儿时，婴儿头部的快速加速 - 减速理论上应对视神经施加足以导致轴突损伤的拉伸或剪切力。β - 淀粉样前体蛋白（β - APP）免疫组织化学最近已被证明是一种识别患有摇晃婴儿综合征婴儿脑内弥漫性轴突损伤的高效方法。在本研究中，我们调查了β - APP在识别遭受致命甩鞭样摇晃的婴儿视神经损伤中的效用。
对年龄小于1岁的患有摇晃婴儿综合征（5例）、合并摇晃婴儿综合征/钝性头部外伤（3例）以及“单纯”钝性头部外伤（1例）的婴儿的眼睛（包括视盘和视神经远端）的福尔马林固定、石蜡包埋切片进行β - 淀粉样前体蛋白免疫组织化学检测。非创伤性对照病例包括死于窒息的婴儿（1例）、婴儿猝死综合征（1例）、体位性窒息（1例）以及1例视网膜母细胞瘤患儿的眼球摘除标本。使用配对的苏木精 - 伊红染色和神经丝染色切片进行比较。
5例摇晃婴儿病例中的3例以及所有3例合并摇晃婴儿/钝性头部外伤病例通过存在强β - APP免疫反应性的串珠状或肿胀轴突节段被鉴定为视神经轴突损伤。在相应的苏木精 - 伊红染色或神经丝染色切片中未检测到轴突损伤。在单纯钝性头部外伤病例或非创伤性对照病例中未见到视神经轴突损伤。
视神经轴突损伤是1岁以下婴儿故意致命甩鞭样头部外伤的一个突出特征。β - 淀粉样蛋白前体免疫组织化学似乎是显示视神经轴突损伤的最有效方法。
