Snyder Vivian S, Hansen Lawrence A
University of California, San Diego - Neuropathology.
Acad Forensic Pathol. 2016 Dec;6(4):608-621. doi: 10.23907/2016.058. Epub 2016 Dec 1.
Fatal, allegedly inflicted pediatric head trauma remains a controversial topic in forensic pathology. Recommendations for systematic neuropathologic evaluation of the brains of supposedly injured infants and children usually include the assessment of long white matter tracts in search of axonopathy - specifically, diffuse axonal injury. The ability to recognize, document, and interpret injuries to axons has significant academic and medicolegal implications. For example, more than two decades of inconsistent nosology have resulted in confusion about the definition of diffuse axonal injury between various medical disciplines including radiology, neurosurgery, pediatrics, neuropathology, and forensic pathology. Furthermore, in the pediatric setting, acceptance that "pure" shaking can cause axonal shearing in infants and young children is not widespread. Additionally, controversy abounds whether or not axonal trauma can be identified within regions of white matter ischemia - a debate with very significant implications. Immunohistochemistry is often used not only to document axonal injury, but also to estimate the time since injury. As a result, the estimated post-injury interval may then be used by law enforcement officers and prosecutors to narrow "exclusive opportunity" and thus, identify potential suspects. Fundamental to these highly complicated and controversial topics is a philosophical understanding of the diffuse axonal injury spectrum disorders.
致命的、据称是遭受的小儿头部创伤在法医病理学中仍然是一个有争议的话题。对于疑似受伤婴儿和儿童大脑进行系统神经病理学评估的建议通常包括评估长白质束以寻找轴索病，特别是弥漫性轴索损伤。识别、记录和解释轴突损伤的能力具有重要的学术和法医学意义。例如，二十多年来分类学的不一致导致包括放射学、神经外科、儿科学、神经病理学和法医病理学在内的各个医学学科之间对弥漫性轴索损伤的定义存在混淆。此外，在儿科领域，认为“单纯”摇晃会导致婴幼儿轴索剪切的观点并不普遍。此外，在白质缺血区域内是否能够识别轴索创伤也存在诸多争议，这一争论具有非常重大的影响。免疫组织化学不仅经常用于记录轴索损伤，还用于估计受伤后的时间。因此，执法人员和检察官可能会利用估计的损伤后间隔来缩小“唯一机会”，从而确定潜在嫌疑人。这些高度复杂且有争议的话题的基础是对弥漫性轴索损伤谱系障碍的哲学理解。
