Technical communication: rationale and technique for examination of nervous system in suspected infant victims of abuse

Most victims of fatal child abuse are under the age of 2 years and have a fairly typical pattern of injuries that involve the brain and spinal cord. Documenting these injuries in a systematic fashion is of paramount importance in establishing the cause and manner of death. Although the importance of recognizing these injuries is widely understood, there are few guidelines for the optimal examination of the central nervous system to document these changes. A standard procedure for postmortem dissection of the brain and spinal cord that preserves the anatomy of the cervicomedullary junction is outlined. Changes in the cervicomedullary junction and spinal cord are an underappreciated marker for shaking injury in children. This technique, along with examination of the eyes and optic nerves, will optimally identify the injuries associated with shaking injuries. A standard series of histologic sections are also outlined to document the corresponding microscopic changes.