The importance of optic nerve sheath hemorrhage as a postmortem finding in cases of fatal abusive head trauma: A 13-year study in a tertiary hospital

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The importance of optic nerve sheath hemorrhage as a postmortem finding in cases of fatal abusive head trauma: A 13-year study in a tertiary hospital Supot Puanglumyai, Suree Lekawanvijit Forensic Science International Volume 276, Pages 5-11 (July 2017) DOI: 10.1016/j.forsciint.2017.04.008 Copyright © 2017 Elsevier B.V. Terms and Conditions

Fig. 1 Subdural optic nerve sheath hemorrhage (ONSH) in cases of fatal abusive head trauma. Upper panel (cases #1 and #5 in Table 1) demonstrates bilateral ONSH that is clearly evident after brain removal. ONSH in AHT typically initiates from the attaching point to the eyeball (left lower panel, arrows), extends distally and does not connect to the intracranial subdural/subarachnoid hemorrhage. A careful in situ examination is crucially required in cases with minimal ONSH which is more difficult to evaluate in removed specimens (left lower panel, inset). Unilateral ONSH is observed in case #3 (Table 1) (right lower panel). Forensic Science International 2017 276, 5-11DOI: (10.1016/j.forsciint.2017.04.008) Copyright © 2017 Elsevier B.V. Terms and Conditions

Fig. 2 Histology of subdural optic nerve sheath hemorrhage (ONSH). Upper panel shows a sagittal section through the eyeball and retrobulbar portion of the optic nerve. Lower panel: numerous extravasated red blood cells (asterisks) between the dura (arrows outlining the innermost surface) and arachnoid (open arrowheads) maters represent subdural ONSH. Note: retinal hemorrhage is observed in this case (arrowhead, upper panel) (case #11 in Table 1). Hematoxylin and eosin stain. Forensic Science International 2017 276, 5-11DOI: (10.1016/j.forsciint.2017.04.008) Copyright © 2017 Elsevier B.V. Terms and Conditions

Fig. 3 Unremarkable optic nerve in a case of accidental head trauma. Representative images of accidental head trauma (case #10 in Table 3) show a transverse fracture line at the base of the skull (arrows). Both optic nerves are unremarkable (asterisks). Forensic Science International 2017 276, 5-11DOI: (10.1016/j.forsciint.2017.04.008) Copyright © 2017 Elsevier B.V. Terms and Conditions