Lundesgaard Eidahl Johanna Marie, Opdal Siri Hauge, Rognum Torleiv Ole, Stray-Pedersen Arne
Department of Forensic Sciences, Group of Paediatric Forensic Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Forensic Sciences, Group of Paediatric Forensic Medicine, Oslo University Hospital, Oslo, Norway.
J Forensic Leg Med. 2019 May;64:1-6. doi: 10.1016/j.jflm.2019.03.003. Epub 2019 Mar 5.
Postmortem evaluations of cerebral edema typically involve examinations of macroscopic features such as the presence of pressure signs and compression of the ventricles. Global massive edema is easily detectable in an autopsy, but less-extensive edema may be difficult to diagnose.
The aim of this study was to compare measurements of brain water contents, postmortem CT radiodensity and brain weight to skull size in edematous and nonedematous brains in order to develop an objective method for postmortem evaluations of brain edema.
Fifty-four subjects autopsied at Oslo University Hospital underwent a standard forensic postmortem examination, including a computed axial tomography (CT) scan, measurement of brain weight, and macroscopic evaluation of the brain. CT images were used to roughly measure the inner skull circumference. The water content of the brain was determined by excising samples of approximately 1 g of brain tissue from eight different areas of the brain surface, drying them, and measuring their percentage water content.
The main finding was a significant relationship between brain weight and inner skull circumference, with the ratio between these two parameters being significantly higher in cases with severe postmortem brain edema than in cases with very little or no brain edema. The water content did not differ significantly between the edema and nonedema cases. There were no significant changes in radiodensity.
This indicates that the brain-weight-to-inner-skull-circumference ratio may serve as a good marker for severe brain edema in postmortem diagnostics, whereas measurements of water content can be misleading.
脑水肿的尸检评估通常涉及对宏观特征的检查，如压力迹象的存在和脑室受压情况。全身性重度水肿在尸检中很容易被发现，但程度较轻的水肿可能难以诊断。
本研究的目的是比较水肿和非水肿脑的脑含水量、尸检CT放射密度以及脑重量与颅骨大小的测量结果，以便开发一种用于脑水肿尸检评估的客观方法。
在奥斯陆大学医院接受尸检的54名受试者接受了标准的法医尸检，包括计算机断层扫描（CT）、脑重量测量以及对大脑的宏观评估。CT图像用于粗略测量颅骨内周长。通过从脑表面的八个不同区域切下约1克脑组织样本，干燥后测量其含水量百分比来确定脑含水量。
主要发现是脑重量与颅骨内周长之间存在显著关系，在重度尸检脑水肿病例中，这两个参数的比值显著高于轻度或无脑水肿病例。水肿和非水肿病例的含水量没有显著差异。放射密度没有显著变化。
这表明脑重量与颅骨内周长的比值可作为尸检诊断中重度脑水肿的良好指标，而含水量测量可能会产生误导。
