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Journal Article

Citation

Gill J, Morotti R, Tranchida V, Morhaime J, Mena H. Pediatr. Dev. Pathol. 2013; ePub(ePub): ePub.

Copyright

(Copyright © 2013, SAGE Publications)

DOI

10.2350/07-02-0236

PMID

17378680

Abstract

Background: A spectrum of neuropathology occurs in infants who sustain traumatic brain injury (TBI). Due to a prolonged survival interval, there is a risk that these deaths may not be recognized as a sequel of trauma. Methods: We reviewed the records of 5 delayed fatalities due to non-accidental infant head injury in New York City that had survival intervals from 2.5 to 17 years. Results: The head injuries occurred at 2-3 months of age and death occurred at 2.5 to 17 years of age. Initially, they were reported as natural deaths by treating physicians, families, and/or police. All five infants had unexplained or poorly explained remote traumatic head injury that included subdural hematomas. At autopsy, the neuropathologic exam demonstrated remote subdural hemorrhages and lesions related to chronic hypoxic-ischemic injury including atrophy, arterial infarcts, border-zone infarcts, and cystic encephalomalacia. Each child survived the initial injury but later succumbed to the delayed effects of secondary hypoxic-ischemic encephalopathy. Conclusion: These five deaths highlight the need to investigate independently the medical history of any child (or adult) who dies with a clinical diagnosis of "cerebral palsy". The term cerebral palsy often is used as a catchall for any patient who has had neurologic impairment since infancy or childhood. If there is a direct link between the initial injury and the death, even if the injury occurred many years before death, then the injury is the proximate cause of death and dictates the manner of death. All five deaths were certified as homicides.


Language: en

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