Pediatric fatal head and neck injury in a 9-year medical examiner case series: autopsy findings and cervical spine dissection techniques

BACKGROUND: Fatal inflicted head injury in infants requires systematic postmortem evaluation of intracranial, ocular, and cervicomedullary structures. This study summarizes autopsy findings in homicidal blunt head trauma in infants under one year of age and describes an en bloc cervical spine dissection approach intended to improve assessment of the cranio cervical region. METHODS: A retrospective review was performed at the Cook County Medical Examiner's Office, Chicago, Illinois, USA, covering 2015 to 2023. Included cases were infants under one year of age with homicide certification and blunt force head injury. Autopsy reports, radiology, neuropathology, and ophthalmology were reviewed, with investigative and child welfare records when available. Injuries were mainly categorized across cranial, spinal, and ocular. RESULTS: Sixty one infant homicides were identified; thirty nine met inclusion criteria. Acute subdural hemorrhage and subarachnoid hemorrhage were each present in 35 of 39 cases (89.7%). Retinal hemorrhages occurred in 34 of 39 (87.2%), with bilateral involvement in 31 (79.5%). Perineural optic nerve subdural hemorrhage was present in 33 (84.6%), bilateral in 32 (82.1%). Skull fractures were identified in 18 (46.2%). Cervical spinal cord injury was documented in 16 (41.1%), most commonly hemorrhagic. Remote extracranial fractures were present in 26 (66.7%), and recent extracranial fractures in 16 (41.1%). CONCLUSION: Intracranial and ocular hemorrhages were frequent in this large medical examiner series, and cervical spinal cord injury was common. The findings support targeted evaluation of the cervical spine in selected infant homicide cases, with en bloc techniques as a useful option when resources and expertise permit.