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By
Dr. Enas Mohamed AmeenDemonstrator of forensic medicine & clinical
toxicology
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How to Comment on Forensic specimen
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-Diagnosis-Presenting part
-Description of the lesion-Causative agent + Mechanical cause (if present)
-Complications-Cause of Death
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Head Injuries
-Scalp injuries-Facial injuries -Fractures of the Skull-Intracranial injuries
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Scalp injuries
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Anatomy of the scalp
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Anatomy of the skull & meninges
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Diagnosis:Lacerations of the Scalp
-Presenting part ( Scalp + Face)-Description of the lesion
.simulating cut wound ( Blunt trauma split the skin & tissues into sharply-demarcated fashion)
.Close examination using a lens ( Bruised edges, hairs cross within the wound, tissue bridges , small nerves & vessels within the depth)
-Causative agent (Blunt trauma)-Complications . Infection (spread via emissary veins or fissure to interior of the
skull causing meningitis, brain abscess, thrombosis of venous sinusis) .Hge (scalp rich in bood supply) . Associated brain injury .Concussion &post-concussion syndrome
-M.L.I may reproduce pattern of inflicting weapon
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Complications: Associated subdural Hge, subarachnoid He, cerebral laceration or contusion
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Diagnosis:Cut wound of the Scalp
Presenting part ( Scalp + Face)-Description of the lesion
.regular clean cut edges .Close examination using a lens (hairs sharply cut, NO tissue bridges , NO
small nerves & vessels within the depth, NO abrasions or bruises at the edges)-Causative agent (heavy sharp object)
-Complications . Infection (spread via emissary veins or fissure to interior of the skull causing
meningitis, brain abscess, thrombosis of venous sinusis) .Hge (scalp rich in bood supply) . Associated brain injury .Concussion &post-concussion syndrome
-M.L.I may reproduce pattern of inflicting weapon
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Skull Fractures
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Complication: post-traumatic epilepsy as mesodermal scarring of cortex irritate the brain (if infection occurred)
M.L.I: may reproduce pattern of inflicting weapon & where it 1st strikes
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Presenting part ( skull)-Description of the lesion
.fracture-Causative agent (blunt impact)
-Mechanics:FOCAL IMPACT-MOMENTARY DISTORTION OF THE SHAPE OF CRANIUM->INTRUSION & EXTRUSION AREAS->IIF DISTORTION EXCEEDS ELASTICITY -> FRACTURE AT INTRUDED & EXTRUDED AREAS
-Complications . Infection (spread via –direct spread in compound fracture infected scalp injuries,
nasal cavity , paranasal sinuses causing meningitis, brain abscess, thrombosis of venous sinusis) .extradural Hge (if crack passes through embedded meningeal artery) . Associated brain injury .Concussion &post-concussion syndrome
-Cause of death
.Immediate: fatal concussion, brain laceration, compression
.delayed: sepsis , epilepsy
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Black Eye
• D.D-Direct violence-Gravitational movement of blood beneath ant.
Scalp from a hematoma or bruise-fracture base ( ant. Fossa)
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Nose -> ant fossa ear-> middle fossa
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Meninges
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DuraArachnoidPia
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Extradural HgeBleeding between inner surface of skull & duraPresenting part ( brain)
-Description of the lesion . Extradural hge-Mechanical cause
.Rupture of middle meningeal a. transected by fracture lineLeakage of high pressure arterial blood strips back dura with progressive accumulation of hematoma. Torn venous sinuse
-Complications .Concussion &post-concussion syndrome
.Compression
.Herniation
.Neurological sequelea (retrograde amnesia, post-traumatic neurosis, epilepsy, sepsis, perminant infirmity. Aphasia if lt. frontal lobe involved broca’s area)
-Cause of death : fatal concussion, compression, brain laceration , intracranial sepsis , epilepsy)
-M.L.I: IF DISCHARGED and death occurs ( negligence against unsuspecting doctor))
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Chronic Subdural HgeBleeding beneath the duraPresenting part ( brain)
-Description of the lesion . Chronic subdural he (describe)-Mechanical cause
.repeated minor trauma -Complications .Concussion &post-concussion syndrome
.Compression( ++ ICT) due to ++ size of hematoma
.Herniation & DAMAGE TO VITAL centers in brainstem
.Neurological sequelea (dementia, neurosis, epilepsy, sepsis,. Deterioration of concious level)
-Cause of death : fatal concussion, compression, herniation , associated brain laceration , intracranial sepsis , epilepsy)
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Intracerebral HgePresenting part ( brain cerebral hemishere)
-Description of the lesion . Intracerebral hge ( DESCRIBE))-Mechanical cause
.due to natural causes as hypertension or trauma (from branches of middle cerebral a.)
-Complications .Concussion &post-concussion syndrome
.Compression( ++ ICT)
.Herniation & DAMAGE TO VITAL centers in brainstem
.Neurological sequelea (dementia, neurosis, epilepsy, sepsis,. Deterioration of concious level). Associated brain damage ( cerebral edema)
-Cause of death : fatal concussion, compression, herniation , associated brain laceration , intracranial sepsis , epilepsy)
--M.L.I: IF DISCHARGED and death occurs ( negligence against unsuspecting doctor))