Datation histologique des lésions hémorragiques intracrâniennes dans le cadre des traumatismes crâniens de l'enfant

Abstract : Introduction: In the context of lethal non-accidental head injuries, the expert pathologist is asked to date the mechanisms that led to the lesions in relation to death while relying on data from the literature. These data have been established on cohorts of adults. The main objective of our study was to propose a child-specific intracranial haemorrhage dating scheme in order to improve the accuracy and reliability of the anatomopathological forensic expertise in the context of the TCNA. The secondary objectives of this study were an inventory of samples taken in the context of a paediatric forensic autopsy, and to collect descriptive data on intracranial haemorrhages resulting in death in a French paediatric population. Material and method: The sample came from a retrospective, multicenter collection of 235 deceased children aged between 0 and 36 months who had forensic pathology expertise. Only infants in whom at least one intracranial haemorrhage was diagnosed at autopsy and on pathological examination, and for whom the schedule for the trauma or bleeding event was known or consistent with the forensic data, been included. The histomorphological study was performed by two anatomopathologists blinded to the survey data. Main results: 83 patients were included in the study (35 girls, 48 boys) with a median age of 3.79 months. Our work allowed to develop histopathological dating patterns of intracranial haemorrhages (HSD, HSA and HR) and intracerebral lesions in children under 3 years old. The role of the expert remains essential to qualify the multiplicity of episodes, although the dating of these different episodes is very difficult. It also made it possible to take stock of intracranial haemorrhages in paediatrics and in particular in the framework of the TCNA. Discussion: In the vast majority of cases the expert, rather than approaching a precise dating, especially when the samples are insufficient, can only: - confirm or refute if the alleged dates (survey data) are consistent with the pathological (macroscopic and microscopic); - to propose a time interval during which the violence could have taken place. Our study has emphasized the importance of coding systematic sampling in the context of paediatric intracranial haemorrhage. For this reason, we have established a defined protocol for the samples to be taken for the pathological examination and the necessary information to be included in the autopsy report. Conclusion and perspectives: Our dating schemes should therefore be used for forensic pathological forensic expertise in the context of the TCNA in children.
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Clémence Delteil. Datation histologique des lésions hémorragiques intracrâniennes dans le cadre des traumatismes crâniens de l'enfant. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01977916⟩

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