2026 – Abstract 5

by | Aug 13, 2026 | 2026 Abstracts

Category: Clinical Science

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

  1. Describe the source of optic nerve sheath hemorrhage following head injury

COI Disclosure:

I do not have a relationship with a for-profit and/or a not-for-profit organization to disclose.

Presenter

Marc R. Del Bigio

Marc R. Del Bigio

Department of Pathology, University of Manitoba & Shared Health Manitoba, Winnipeg MB Canada

Target Audience:

Pathologists
Residents

CanMEDS:

Medical Expert (the integrating role)
Scholar

Source of optic nerve dural sheath hemorrhage in children with head trauma

Abstract

Optic nerve (ON) sheath hemorrhage is commonly observed in cases of childhood head trauma.  My objective is to determine the bleeding source. From 1997 to 2025, 122 pediatric autopsy cases included bilateral ON.  Routine stains were H&E, Martius scarlet blue (MSB), and Perls’ Prussian blue (PPB).  Hemorrhage within the ON sheaths was seen in 74 cases.  To identify the source of hemorrhage, the anterior ON of 6 cases with survival <12 hours were serially sectioned at 100um steps and stained with MSB.  Select slides had additional stains.  Six normal ON were similarly processed.
The central retinal artery and vein course through the center of the ON for a few mm adjacent to the globe before radial passage to the ON surface, where venous anatomy was variable. The artery and vein usually traverse the dural sheath together.  In cases with hemorrhage, there was always more subdural than subarachnoid blood. Blood collections often extended the entire length of the ON.  However, communication with the retina or the intracranial subarachnoid compartment is not possible because collagenous stroma of the ON is integrated with the sclera or optic canal dura mater.  In 6/6 hemorrhagic cases, focal disruption of the central retinal vein was identified at or near its entry into the dural sheath. Optic nerve sheath hemorrhage arises from disruption of the central retinal vein where it exits the dural sheath. The mechanism is not clear; it result from relative movement or a pressure wave phenomenon during the traumatic event.