Possibility of ocular fundus hemorrhages and retinal folds in diagnosis of child abuse

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K09261
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Legal medicine
• Research Institution: Kurume University (2019); Akita University (2017-2018)
• Principal Investigator: OSHIMA Toru 久留米大学, 医学部, 准教授 (70464427)
• Co-Investigator(Kenkyū-buntansha): 大谷 真紀 秋田大学, 医学系研究科, 助教 (30292379) ; 美作 宗太郎 秋田大学, 医学系研究科, 教授 (50284998)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: 法医学 / 子どもの虐待 / 揺さぶられっ子症候群 / 眼科学 / 眼底出血 / 出血性網膜ひだ / 視神経鞘出血 / 網膜前出血

Outline of Final Research Achievements

In three infant cases of non-accidental head trauma, we found perimacular retinal folds (RF), which is considered to be caused by violent vitreous traction. In four infant cases of head trauma, we found sub-internal limiting membrane (ILM) hemorrhages primarily in the post pole and peripheral retina, which is considered to be caused by vitreous traction. Diffuse sub-ILM hemorrhages were reported in an infant with coagulopathy. We should carefully consider the mechanism of sub-ILM hemorrhage in each case. We found retinal hemorrhages (RH) in seven cases. However, there was no relationship between RH and cause of death or post vitreous detachment. In three cases of intracranial injury with occipital impact and fracture, peripapillary scleral hemorrhages (PSH) were found. We considered that perimacular RF and PSH were specifically caused by acceleration-deceleration head trauma. However, more cases are needed to determine whether these findings can help identify child abuse.

Free Research Field

法医学

Academic Significance and Societal Importance of the Research Achievements

本研究の目的は法医解剖例における網膜剥離や眼底出血の発症機序を明らかにすることである．期間中，出血性網膜ひだ（網膜分離），網膜前出血（内境界膜下出血），網膜出血，視神経鞘出血等の所見を認めた．一口に「眼底出血」といっても，種類や成傷機転は様々で，それが病的なものか，頭部加速度損傷なのか，虐待を疑う症例なのかの判別については，個々の病変を総合的に考察する必要がある．近年よく用いられている「広範で多発性・多層性・多形性の網膜出血，網膜ひだ，網膜分離症」 は虐待を疑うスクリーニングとしては有用であるが，これらの所見のみをもって確定診断とするには不充分であると考えられた．