Budenz D L, Farber M G, Mirchandani H G, Park H, Rorke L B
William C. Frayer Laboratory of Eye Pathology, Scheie Eye Institute, University of Pennsylvania, Philadelphia 19104.
Ophthalmology. 1994 Mar;101(3):559-65. doi: 10.1016/s0161-6420(94)31300-5.
To ascertain whether the pathology of the eye and optic nerve might be useful in determining the manner of death in infants who died after sustaining apparent nonaccidental intracranial injury.
Complete autopsies were performed on 13 infants who died of acute intracranial injuries after nonaccidental trauma. The infants were divided into two groups: nine with physical evidence of blunt trauma to the head, and four without detectable scalp or skull injury whose intracranial injuries were attributed to violent shaking (shaken baby syndrome). Six infants with no intracranial injuries who died suddenly from unidentifiable causes (the so-called sudden infant death syndrome) served as controls.
Optic nerve sheath hemorrhage, most prominent in the subdural space, was present in all 13 infants with nonaccidental intracranial injury. Multilayered retinal hemorrhage was present in at least one eye of 11 of these 13 infants. The location and quantity of the intraocular and optic nerve sheath hemorrhages did not differ in those with external head trauma and those without scalp or skull lesions. A single control infant had a few erythrocytes in the nerve fiber layer of the anterior optic nerve of one eye. The remainder of the control infants did not have evidence of hemorrhage in the eye or optic nerve sheath.
Histopathologic analysis of optic nerve sheath and intraocular hemorrhages may be helpful in distinguishing traumatic from non-traumatic causes of death in infants.
确定眼部和视神经的病理学表现是否有助于判定在遭受明显非意外性颅内损伤后死亡的婴儿的死亡方式。
对13例因非意外性创伤导致急性颅内损伤死亡的婴儿进行了完整的尸检。这些婴儿被分为两组：9例有头部钝器伤的物证，4例未检测到头皮或颅骨损伤，其颅内损伤归因于剧烈摇晃（摇晃婴儿综合征）。6例无颅内损伤、死因不明突然死亡的婴儿（所谓的婴儿猝死综合征）作为对照。
13例非意外性颅内损伤的婴儿均出现视神经鞘出血，最显著的是在硬膜下间隙。这13例婴儿中有11例至少一只眼睛存在多层视网膜出血。有头部外伤的婴儿和无头皮或颅骨损伤的婴儿，其眼内和视神经鞘出血的部位和数量并无差异。1例对照婴儿一只眼睛的视神经前部神经纤维层有少量红细胞。其余对照婴儿未发现眼部或视神经鞘出血的证据。
对视神经鞘和眼内出血进行组织病理学分析可能有助于区分婴儿创伤性和非创伤性死亡原因。
