Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining.

Abstract

OBJECTIVE:

Accurate identification of diffuse axonal injury is important in the forensic investigation of infants who have died from traumatic brain injury. beta-Amyloid precursor protein (beta-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 beta-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 beta-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 beta-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, hematoxylineosin 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 beta-APP immunoreactivity was observed in any of the 7 control cases.

CONCLUSIONS:

Immunostaining for beta-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.

• Authors: A M Gleckman, M D Bell, R J Evans, T W Smith
• Journal: Archives of pathology & laboratory medicine (Arch Pathol Lab Med) Vol. 123 Issue 2 Pg. 146-51 (Feb 1999) ISSN: 0003-9985 [Print] United States
• PMID: 10050789 (Publication Type: Journal Article)

Chemical References

• Amyloid beta-Protein Precursor

Topics

• Adult
• Amyloid beta-Protein Precursor (analysis)
• Axons
• Battered Child Syndrome (pathology)
• Brain (pathology)
• Brain Injuries (pathology)
• Child
• Child, Preschool
• Female
• Humans
• Immunohistochemistry
• Infant
• Male