Abstract
Objective.—Accurate identification of diffuse axonal injury is important in the forensic investigation of infants who have died from traumatic brain injury. β-Amyloid precursor protein (β-APP) immunohistochemical staining is highly sensitive in identifying diffuse axonal injury. However, the effectiveness of this method in brain-injured infants has not been well established. The present study was undertaken to assess the utility of β-APP immunohistochemistry in detecting diffuse axonal injury in infants with either shaken baby syndrome or blunt head trauma.
Materials and Methods.—Archival formalin-fixed, paraffin-embedded blocks from infants (<1 year old) with shaken baby syndrome (7 cases) and blunt head trauma (3) and blocks from 7 control cases that included nontraumatic cerebral edema (1), acute hypoxic-ischemic encephalopathy (1), and normal brain (5) were immunostained for β-APP. A semiquantitative assessment of the severity of axonal staining was made. Corresponding hematoxylin-eosin–stained sections were examined for the presence of axonal swellings.
Results.—Immunostaining for β-APP identified diffuse axonal injury in 5 of 7 infants with shaken baby syndrome and 2 of 3 infants with blunt head trauma. Immunoreactive axons were easily identified and were present in the majority of the sections examined. By contrast, hematoxylin-eosin staining revealed axonal swellings in only 3 of 7 infants with shaken baby syndrome and 1 of 3 infants with blunt head trauma. Most of these sections had few if any visible axonal swellings, which were often overlooked on initial review of the slides. No β-APP immunoreactivity was observed in any of the 7 control cases.
Conclusions.—Immunostaining for β-APP can easily and reliably identify diffuse axonal injury in infants younger than 1 year and is considerably more sensitive than routine hematoxylin-eosin staining. We recommend its use in the forensic evaluation of infants with fatal craniocerebral trauma.
Concomitant abducens and facial nerve palsies following blunt head trauma associated with bone fracture
