Are Peripapillary Intrascleral Hemorrhages Pathognomonic for Abusive Head Trauma?

Candace H. Schoppe, Patrick E. Lantz

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


The American Academy of Pediatrics' Committee on Child Abuse and Neglect, Section on Ophthalmology, acknowledges that searching for retinal hemorrhages (RHs) in infants only in cases of suspected of abuse creates selection bias. However, they also recommend that postmortem eye removal might not be indicated "in children who have clearly died from witnessed severe accidental head trauma or otherwise readily diagnosed systemic medical conditions." Although infrequently described in the child abuse literature, peripapillary intrascleral hemorrhages (bleeding in the sclera at the optic nerve insertion)-putatively from severe repetitive acceleration/deceleration forces with or without blunt head trauma-have been considered essentially pathognomonic for abusive head trauma (shaken baby syndrome). We present two neonates who sustained accidental, severe in utero head injuries and had associated extensive RHs and optic nerve sheath hemorrhages with peripapillary intrascleral hemorrhages detected at autopsy. Neither neonate had a documented clinical fundal examination in the intensive care unit.

Original languageEnglish (US)
Pages (from-to)228-231
Number of pages4
JournalJournal of Forensic Sciences
Issue number1
StatePublished - Jan 2013


  • Abusive head trauma
  • Accident
  • Forensic science
  • Optic nerve sheath hemorrhage
  • Peripapillary intrascleral hemorrhage
  • Postmortem monocular indirect ophthalmoscopy
  • Retinal hemorrhages
  • Shaken baby syndrome
  • Skull fractures

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Genetics


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