Skip to main content
SpringerLink
Log in

Histopathologische Diagnostik beim letalen Schütteltrauma

Histopathological diagnostics in fatal shaken baby syndrome

  • Leitthema
  • Published:
Rechtsmedizin Aims and scope Submit manuscript

Zusammenfassung

Nach tödlich verlaufenen Fällen eines Schütteltraumas müssen Befunde, die die entsprechende Gewalteinwirkung belegen, im Rahmen der Obduktion und durch nachfolgende histologische Untersuchungen erhoben werden. Dies gilt v. a. für jene Schütteltraumaopfer, bei denen zu Lebzeiten keine klinische Diagnostik mehr erfolgen konnte. Aber auch ein antemortal bekannter Verdacht auf ein Schütteltrauma mit klassischen Befunden, wie z. B. einem subduralen Hämatom und retinalen Blutungen, gelegentlich auch mit paravertebralen Rippenfrakturen und subkutanen Einblutungen (Thorax, Oberarme), bedarf der autoptischen Beweissicherung. Wurde das Schütteltrauma zunächst überlebt, können Fragen der Altersbestimmung von Verletzungen relevant werden.

Abstract

In fatal courses of shaken baby syndrome (SBS, non-accidental head injury, NAHI) findings that confirm the classical signs of this special form of violence must be collected during the autopsy and the subsequent histological investigations. This is particularly important for all victims of shaking trauma where clinical diagnostics could no longer be carried out during life. Even in cases where there was a known antemortem suspicion of shaken baby syndrome with typical autopsy findings, such as subdural hematoma and retinal hemorrhage, also occasionally with paravertebral rib fractures and subcutaneous bleeding (thorax, upper limbs), evidence needs to be collected during an autopsy. If the child initially survives the shaking trauma, questions on the age determination of injuries can be relevant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Arlotti SA, Forbes BJ, Dias MS, Bonsall DJ (2007) Unilateral retinal hemorrhages in shaken baby syndrome. J AAPOS 11:175–178

    Article  Google Scholar 

  2. Baum JD, Bulpitt CJ (1970) Retinal and conjunctival haemorrhage in the newborn. Arch Dis Child 45:344–349

    Article  CAS  Google Scholar 

  3. Betz P, Püschel K, Miltner E, Lignitz E, Eisenmenger W (1996) Morphometrical analysis of retinal hemorrhages in the shaken baby syndrome. Forensic Sci Int 78:71–80

    Article  CAS  Google Scholar 

  4. Caffey J (1972) On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child 124:161–169

    Article  CAS  Google Scholar 

  5. Dettmeyer R (2018) Forensic Histopathology, 2. Aufl. Springer, Heidelberg

    Book  Google Scholar 

  6. Dettmeyer R (2016) Postmortale Diagnostik einer (post-)viralen Myokarditis bei mutmaßlichem plötzlichem Säuglingstod. Fallbericht zur Fehlervermeidung bei der Diagnostik. Rechtsmedizn 26:514–519

    Article  Google Scholar 

  7. DiMaio VJM, Dana SE (2007) Handbook of forensic pathology, 2. Aufl. Taylor & Francis, Boca Raton, London, New York

    Google Scholar 

  8. Duhaime AC, Alario AJ, Lewander WJ et al (1992) Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 90:179–185

    CAS  PubMed  Google Scholar 

  9. Emerson MV, Pieramici DJ, Stoessel KM, Berreen JP, Gariano RF (2001) Incidence and rate of disappearance of retinal hemorrhage in newborns. Ophthalmology 108:36–39

    Article  CAS  Google Scholar 

  10. Gago LC, Wegner RK, Capone A Jr, Williams GA (2003) Intraretinal hemorrhages and chronic subdural effusions: glutaric aciduria type 1 can be mistaken for shaken baby syndrome. Retina 23:724–726

    Article  Google Scholar 

  11. Gilliland MG, Luckenbach MW (1993) Are retinal hemorrhages found after resuscitation attempts? A study of the eyes of 169 children. Am J Forensic Med Pathol 14:187–192

    Article  CAS  Google Scholar 

  12. Gilliland MG, Luthert P (2003) Why do histology on retinal haemorrhages in suspected non-accidental injury? Histopathology 43:592–602

    Article  CAS  Google Scholar 

  13. Gilliland MG, Luckenbach MW, Chenier TC (1994) Systemic and ocular findings in 169 prospectively studied child deaths: retinal hemorrhages usually mean child abuse. Forensic Sci Int 68:117–132

    Article  CAS  Google Scholar 

  14. Gilliland MG, Levin AV, Enzenauer RW et al (2007) Guidelines for postmortem protocol for ocular investigation of sudden unexplained infant death and suspected physical child abuse. Am J Forensic Med Pathol 28:323–329

    Article  CAS  Google Scholar 

  15. Gleckman AM, Bell MD, Evans RJ, Smith TW (1999) Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining. Arch Pathol Lab Med 123:146–151

    CAS  PubMed  Google Scholar 

  16. Kanter RK (1986) Retinal hemorrhage after cardiopulmonary resuscitation or child abuse. J Pediatr 108:430–432

    Article  CAS  Google Scholar 

  17. Küppers L, Hartung B, Karenfort M, Ritz-timme S (2017) Schütteltrauma vs. Impfkomplikation. Eine kritische Analyse und Literaturübersicht. Rechtsmedizin 27:491–496

    Article  Google Scholar 

  18. Matschke J (2008) Historischer Überblick des nichtakzidentellen SChädel-Hirn-Traumas im Säuglings- und Kleinkindalter. Rechtsmedizin 18:7–8

    Article  Google Scholar 

  19. Matschke J, Glatzel M (2008) Neuropathologische Begutachtung des nichtakzidentellen Schädel-Hirn-Traumas bei Säuglingen und Kleinkindern. Rechtsmedizin 18:29–35

    Article  Google Scholar 

  20. Matschke J, Püschel K, Glatzel M (2009) Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury. Int J Legal Med 123:189–197

    Article  Google Scholar 

  21. Matschke J, Herrmann B, Sperhake J, Körber F, Bajanowski T, Glatzel M (2009) Das Schütteltrauma-Syndrom. Dtsch Ärztbl Int 106:211–217

    Google Scholar 

  22. Munger CE, Peiffer RL, Bouldin TW, Kylstra JA, Thompson RL (1993) Ocular and associated neuropathologic observations in suspected whiplash shaken infant syndrome. A retrospective study of 12 cases. Am J Forensic Med Pathol 14:193–200

    Article  CAS  Google Scholar 

  23. Pounder DJ (1997) Shaken adult syndrome. Am J Forensic Med Pathol 18:321–324

    Article  CAS  Google Scholar 

  24. Scheller J, Doroslovacki P (2015) Ruptured aneurysm and terson syndrome. Pediatr Neurol 52:653–654

    Article  Google Scholar 

  25. Schmidt U, Hahn G, Geiger K, Erfurt C (2016) Extrakranielle Verletzungen bei schwerem Schütteltrauma. Rechtsmedizin 26:29–33

    Article  Google Scholar 

  26. Sezen F (1971) Retinal haemorrhages in newborn infants. Br J Ophthalmol 55:248–253

    Article  CAS  Google Scholar 

  27. Sherriff FE, Bridges LR, Sivaloganathan S (1994) Early detection of axonal injury after human head trauma using immunocytochemistry for beta-amyloid precursor protein. Acta Neuropathol 87:55–62

    Article  CAS  Google Scholar 

  28. Sperhake J, Matschke J (2014) „Shaken baby syndrome“ and forensic pathology. Forensic Sci Med Pathol 10:251–252

    Article  Google Scholar 

  29. Stray-Pedersen A, Omland S, Nedregaard B, Klevberg S, Rognum TO (2011) An infant with subdural hematoma and retinal hemorrhages: does von Willebrand disease explain the findings? Forensic Sci Med Pathol 7:37–41

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut für Rechtsmedizin, Justus-Liebig-Universität, Frankfurter Str. 58, 35392, Gießen, Deutschland

    R. Dettmeyer, T. Ohlwärther, C. G. Birngruber & J. Lang

Authors
  1. R. Dettmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Ohlwärther
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. G. Birngruber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Dettmeyer.

Ethics declarations

Interessenkonflikt

R. Dettmeyer, T. Ohlwärther, C.G. Birngruber und J. Lang geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dettmeyer, R., Ohlwärther, T., Birngruber, C.G. et al. Histopathologische Diagnostik beim letalen Schütteltrauma. Rechtsmedizin 28, 495–499 (2018). https://doi.org/10.1007/s00194-018-0278-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00194-018-0278-y

Schlüsselwörter

Keywords

Search

Navigation