RESUMO
CONTEXT: Shaken baby syndrome is a controversial topic in forensic pathology. Some forensic pathologists state that shaking alone is insufficient to explain death and that an impact must have occurred even if there is no impact site on the head. OBJECTIVE: To examine a large cohort of fatal, pediatric head injuries for patterns of specific autopsy findings and circumstances that would support or dispute pure shaking as the cause of death. DESIGN: We retrospectively reviewed 59 deaths due to head injuries in children younger than 2 years certified in our office during a 9 year period (1998-2006). The review included autopsy, toxicology, microscopy, neuropathology, and police and investigators' reports. RESULTS: There were 46 homicides, 8 accidents, and 1 undetermined death from blunt-impact injury of the head. In 10 (22%) of the homicides, there was no impact injury to the head, and the cause of death was certified as whiplash shaking. In 4 (40%) of these 10 deaths, there was a history of shaking. In 5 (83%) of the other 6, there was no history of any purported accidental or homicidal injury. All 8 accidental deaths had impact sites. Of the 59 deaths, 4 (6.7%) had only remote injuries (chronic subdural hematomas, remote long bone fractures) that were certified as undetermined cause and manner. These 4 deaths were excluded from the study. CONCLUSIONS: We describe a subset of fatal, nonaccidental head-injury deaths in infants without an impact to the head. The autopsy findings and circumstances are diagnostic of a nonimpact, shaking mechanism as the cause of death. Fatal, accidental head injuries in children younger than 2 years are rare.
Assuntos
Causas de Morte , Síndrome do Bebê Sacudido/mortalidade , Ferimentos não Penetrantes/mortalidade , Encéfalo/patologia , Humanos , Lactente , Cidade de Nova Iorque , Estudos Retrospectivos , Síndrome do Bebê Sacudido/patologiaRESUMO
Hyperextension of the head can cause injury to the vessels at the base of the brain. These lacerations are believed to be caused by stretching of the vessels due to the abrupt movement of the head and rotational acceleration of the brain within the cranium, and they usually occur in the intracranial portions of the vessels, producing a subarachnoid hemorrhage. This is the case of a 35-year-old man who received a blow to the face that forcefully hyperextended and rotated his head to the left. Autopsy revealed an intracranial right internal carotid laceration extending from a calcified atherosclerotic plaque. This unusual injury may be due to a combination of blunt force applied to the head and the alteration of the vessel's structural and functional capacities secondary to atherosclerosis.
Assuntos
Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/patologia , Traumatismos Craniocerebrais/complicações , Hematoma/etiologia , Hemorragia Subaracnoídea Traumática/etiologia , Adulto , Lesões das Artérias Carótidas/patologia , Traumatismos Craniocerebrais/etiologia , Hematoma/patologia , Humanos , Masculino , Traumatismos Maxilofaciais/complicações , Traumatismos Maxilofaciais/etiologia , Rotação/efeitos adversos , Hemorragia Subaracnoídea Traumática/patologia , Dissecação da Artéria Vertebral/etiologia , Dissecação da Artéria Vertebral/patologia , Ferimentos não Penetrantes/complicaçõesRESUMO
Cerebral palsy (CP) is a nonprogressive motor deficit present or sustained in the perinatal period. We reviewed the files of the Office of Chief Medical Examiner of the City of New York for the 1997-2001 interval seeking those with any mention of cerebral palsy. There were 26 such cases, including 18 natural deaths, three accidents, two homicides, two therapeutic complications, and one death classified as undetermined. Proper reporting and careful investigation of these deaths is required for accurate certification of cause and manner of death, as well as for adequate tracking of these deaths for public health purposes.
Assuntos
Paralisia Cerebral/mortalidade , Acidentes/estatística & dados numéricos , Adolescente , Adulto , Causas de Morte , Criança , Pré-Escolar , Feminino , Medicina Legal , Homicídio/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologiaAssuntos
Neurônios Motores/patologia , Debilidade Muscular/etiologia , Febre do Nilo Ocidental , Idoso , Anticorpos Antivirais/imunologia , Antígenos Virais/sangue , Evolução Fatal , Humanos , Masculino , Debilidade Muscular/fisiopatologia , Medula Espinal/patologia , Febre do Nilo Ocidental/complicações , Febre do Nilo Ocidental/patologia , Febre do Nilo Ocidental/fisiopatologia , Vírus do Nilo Ocidental/imunologia , Vírus do Nilo Ocidental/isolamento & purificaçãoRESUMO
Spontaneous cerebellar hemorrhages are a rare but often fatal occurrence in children. Although there are several predisposing factors such as blood dyscrasias or astrocytomas, the most common cause of cerebellar hemorrhage in an otherwise healthy child is the rupture of a vascular malformation. We reviewed the files of the Office of Chief Medical Examiner of the City of New York and found four such instances over a period of less than two years. We present these here and outline the approach the forensic pathologist should take in evaluating such deaths.