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Review
. 2021 Jul;135(4):1481-1498.
doi: 10.1007/s00414-021-02526-x. Epub 2021 Feb 22.

Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

Affiliations
Review

Spinal cord injury as an indicator of abuse in forensic assessment of abusive head trauma (AHT)

Michela Colombari et al. Int J Legal Med. 2021 Jul.

Abstract

Abusive head trauma (AHT) in children is notoriously one of the most challenging diagnoses for the forensic pathologist. The pathological "triad", a combination of intracranial subdural haematoma, cerebral oedema with hypoxic-ischaemic changes and retinal haemorrhages, is frequently argued to be insufficient to support a corroborated verdict of abuse. Data from all available English-language scientific literature involving radiological and neuropathological spinal cord examination is reviewed here in order to assess the contribution of spinal cord changes in differentiating abusive from accidental head trauma. In agreement with the statistically proven association between spinal subdural haemorrhage (SDH) and abuse (Choudhary et al. in Radiology 262:216-223, 2012), spinal blood collection proved to be the most indicative finding related to abusive aetiology. The incidence of spinal blood collection is as much as 44-48% when all the spinal cord levels are analysed as opposed to just 0-18% when the assessment is performed at cervical level only, in agreement with the evidence of the most frequent spinal SDH location at thoracolumbar rather than cervical level. In this review, the source of spinal cord blood collection and how the age of the child relates to the position of spinal cord lesions is also discussed. We concluded that the ante mortem MRI examination and post mortem examination of whole-length spinal cord is of fundamental interest for the assessment of abuse in the forensic setting.

Keywords: Abusive head trauma; Forensic investigation; Shaken baby syndrome; Spinal cord injury; Spinal subdural haemorrhage.

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Conflict of interest statement

Not applicable

Figures

Fig. 1
Fig. 1
Hematoxylin-eosin-stained histological sections of thoracic spinal cord with recent SDH in a 5-month-old female victim of abusive head injury (original magnification ×25). a: dura mater, b: arachnoid, c: pia mater, d: spinal cord, SDH subdural haematoma
Fig. 2
Fig. 2
Hematoxylin-eosin-stained histological sections of spinal cord thoracic segment in a 5-month-old female victim of abusive head injury (original magnification ×50) a: dura mater, b: arachnoid, c: pia mater, d: spinal cord, SDH subdural haematoma
Fig. 3
Fig. 3
Hematoxylin-eosin-stained histological sections of cervical spinal cord with extradural and subdural haematoma in a 5-month-old female victim of abusive head injury (original magnification ×25) a: dura mater, b: arachnoid, c: pia mater, d: spinal cord, SN spinal nerves, EDH extradural haematoma, SDH subdural haematoma
Fig. 4
Fig. 4
βAPP showing axonal injury in the posterior nerve roots in the cervical segment in a 4-week-old female victim of abusive head injury (original magnification ×25). SN spinal nerves
Fig. 5
Fig. 5
βAPP in the posterior nerve roots in cervical segment in a 4-week-old female victim of abusive head injury (original magnification ×50). SN spinal nerves

Comment in

  • Response to Colombari et al. (2021).
    Squier W, Lynøe N, Eriksson A. Squier W, et al. Int J Legal Med. 2022 Jan;136(1):393. doi: 10.1007/s00414-021-02672-2. Epub 2021 Aug 12. Int J Legal Med. 2022. PMID: 34383119 No abstract available.

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