Bogdanović Milenko, Radnić Bojana, Savić Slobodan, Popović Vesna, Durmić Tijana
From the Institute of Forensic Medicine "Milovan Milovanović," University of Belgrade, School of Medicine, Belgrade, Serbia.
Am J Forensic Med Pathol. 2019 Mar;40(1):58-60. doi: 10.1097/PAF.0000000000000444.
We present a case of 19-year-old female patient, who was injured in childhood and subsequently developed hydrocephalus, chronic elevation of intracranial pressure (ICP), and a copper-beaten skull appearance. Chronic hydrocephalus leads to an increase in intraventricular pressure, causing ventricular expansion and dislocation of adjacent cerebral structures. According to literature data, it has been hypothesized that chronically elevated ICP in persons with craniosynostosis, and other developmental structural abnormalities of the skull, may induce bone remodeling. In cases with copper-beaten skull appearance, increased ICP should be considered as a cause of death (after exclusion of all other obvious causes), and for that reason, careful examination of the skull appearance is suggested. This finding could be useful in cases with advanced postmortem changes, where it might indicate some medical conditions of the deceased or could even be considered unique feature for body identification, although this rationale should be used with great caution.
我们报告一例19岁女性患者，她童年时受伤，随后出现脑积水、颅内压（ICP）慢性升高以及“铜击样颅骨”外观。慢性脑积水导致脑室内压力升高，引起脑室扩张和相邻脑结构移位。根据文献资料，有人推测颅缝早闭及其他颅骨发育结构异常患者的ICP长期升高可能会诱导骨重塑。在出现“铜击样颅骨”外观的病例中，应将ICP升高视为死亡原因（排除所有其他明显原因后），因此，建议仔细检查颅骨外观。这一发现对于死后变化较严重的病例可能有用，它可能提示死者的某些疾病状况，甚至可被视为身份识别的独特特征，不过运用这一理论时应极为谨慎。
