By

Dr. Enas Mohamed AmeenDemonstrator of forensic medicine & clinical

toxicology

How to Comment on Forensic specimen

-Diagnosis-Presenting part

-Description of the lesion-Causative agent + Mechanical cause (if present)

-Complications-Cause of Death

Head Injuries

-Scalp injuries-Facial injuries -Fractures of the Skull-Intracranial injuries

Scalp injuries

Anatomy of the scalp

Anatomy of the skull & meninges

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

Complications: Associated subdural Hge, subarachnoid He, cerebral laceration or contusion

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

Skull Fractures

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

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

Black Eye

• D.D-Direct violence-Gravitational movement of blood beneath ant.

Scalp from a hematoma or bruise-fracture base ( ant. Fossa)

Nose -> ant fossa ear-> middle fossa

Meninges

DuraArachnoidPia

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))

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)

-

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))