Abstract #14

by | Sep 18, 2023 | 2023 Abstracts

Abstract 14- 1430-1445
Category: Clinical

At the end of the session, participants will be able to:

  1. Understand the spectrum of ocular pathologies linked to pediatric head trauma
  2. Review the underlying theories of ocular pathology frequently documented in infant head trauma cases

COI Disclosure:

I have a relationship with a for-profit and/or a not-for-profit organization to disclose. Indicate the organization(s) with
which you have/had a relationship over the previous two years and briefly describe the nature of that relationship.

Name of for-profit or not-for-profit organization(s) :
NAAG Forensic PC
Description of relationship(s) : I, Dr. Evan Matshes, as the Medical Director of NAAG Forensic PC, affirm that I do not perceive my role as presenting a conflict in relation to the content of my presentation. My actions are grounded in professional ethics, free from external influences, and prioritize the best interests of relevant parties. I remain dedicated to transparency and uphold the highest standards of professional integrity.

Presenter

Dr. Evan William Matshes is a board certified anatomic and forensic pathologist licensed to practice medicine in the State of California. He is employed at NAAG FORENSIC PC where he is Medical Director. He serves as Chief Forensic Pathologist for multiple statutorily appointed agencies in the State of California. He is an administrator with an active general and pediatric forensic pathology practice. He also provides independent reviews and consultation services for complex injury and death cases for death investigative agencies, law enforcement, the military, and justice professionals worldwide.
His educational background and qualifications include: an undergraduate degree (BSc) in Human Anatomy and Cell Biology from the University of Saskatchewan, and a Medical Doctorate (MD) also from the University of Saskatchewan (Canada). Dr. Matshes holds specialty certification in Anatomic Pathology as a Fellow of the Royal College of Physicians and Surgeons of Canada (FRCPC) by examination, and from the American Board of Pathology (Fellow in the College of American Pathologists; FCAP) by examination. Dr. Matshes also holds specialty certification in Forensic Pathology as a Diplomate of the American Board of Pathology (D-ABP) by examination. Dr. Matshes was selected as the 2007 Harvard Medical School Visiting Scholar in Pediatric Pathology, and trained at the Boston Children’s Hospital. During the final year of his Anatomic Pathology training, Dr. Matshes undertook a nine-month research fellowship in Pediatric Forensic Pathology with the Miami-Dade County Medical Examiner Department.

Authors

Evan W. Matshes1

1NAAG Forensic PC, San Diego, California, USA

    Target Audience:

    Pathologists, Residents, Medical Students

    CanMEDS:
    Medical Expert (the integrating role), Collaborator, Health Advocate

    Eyes or lies? Navigating ocular pathology controversies in infant head trauma.

    Abstract

    For years, the medical community has believed that specific ocular pathologies, including retinal hemorrhages, retinoschisis, macular folds, peripapillary intrascleral hemorrhages, and perioptic nerve sheath hemorrhages, are markers of inflicted pediatric injury with medicolegal significance. The mechanism of injury responsible for these findings was believed to be shaking, impact, or a combination thereof, each with serious legal implications. Despite growing skepticism over the last four decades, a pervasive opinion exists that shaking and/or impact trauma exert “shearing” forces to the eye structures. This proposition, particularly in relation to retinal abnormalities, hinges on the unvalidated “vitreoretinal traction” (VRT) theory. If VRT provides the true pathophysiological basis for intra-ocular hemorrhages, then this finding implies intense force application to an infant’s head. However, extensive reviews of literature and case experience suggest that these pathologies are not exclusively linked to head trauma, particularly deliberate injury. Notably, the foundational research often cited to establish the specificity of ocular pathology in child abuse has undergone considerable scrutiny, with critiques targeting its circular logic and other biases. Thus, a comprehensive and cautious evaluation is needed for the diagnostic value of ocular pathology in child abuse cases.