Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014 Helsinki, Finland; Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014 Helsinki, Finland.
Leg Med (Tokyo). 2024 Sep;70:102495. doi: 10.1016/j.legalmed.2024.102495. Epub 2024 Jul 18.
The postmortem diagnosis of diffuse traumatic axonal injury (dTAI) relies on β-amyloid precursor protein (β-APP) immunohistochemistry. Most reports of factors associating with dTAI are decades old. We compared background characteristics and neuropathology findings of today's Finnish medico-legal autopsy cases with and without β-APP-positive dTAI (dTAI+ and dTAI-, respectively). The cases had suffered a head injury prior to death and underwent a full neuropathological examination including β-APP stain. Background and circumstantial data as well as neuropathology findings were collected from police documents, medical records, and autopsy and neuropathology reports. Prevalence ratios were calculated for each factor to facilitate comparisons between the dTAI+ and dTAI- groups. The dataset comprised 57 cases (66.7% males), with 17 classified as dTAI+ and 40 as dTAI-. Based on prevalence ratios, the factors that had at least two-fold prevalence among dTAI+ cases compared to dTAI- cases were: an unknown injury mechanism; concurrent epidural or subdural haemorrhage; and an accidental manner of death. In contrast, the factors that had at least two-fold prevalence among dTAI- cases compared to dTAI+ cases were: a short postinjury survival (<30 min); concurrent intracerebral/ventricular haemorrhage or contusion; vermal atrophy; and a natural or homicidal manner of death. This study revealed differences in circumstantial features and neuropathology findings between dTAI+ and dTAI- cases in today's medico-legal autopsy material. Data on typical case profiles may help estimate the prior probability of dTAI not only in medico-legal autopsies but also among living patients with head injuries.
弥漫性轴索损伤（dTAI）的死后诊断依赖于β-淀粉样前体蛋白（β-APP）免疫组化。大多数与 dTAI 相关因素的报告都有几十年的历史了。我们比较了今天芬兰法医尸检中β-APP 阳性弥漫性轴索损伤（dTAI+和 dTAI-）病例和无 dTAI 病例的背景特征和神经病理学发现。这些病例在死亡前都遭受过头部损伤，并接受了包括β-APP 染色在内的全面神经病理学检查。背景和环境数据以及神经病理学发现均从警察文件、医疗记录以及尸检和神经病理学报告中收集。为了便于比较 dTAI+和 dTAI-组，对每个因素计算了患病率比。该数据集包含 57 例（66.7%为男性），其中 17 例被归类为 dTAI+，40 例为 dTAI-。根据患病率比，在 dTAI+病例中至少有两倍于 dTAI-病例的因素有：未知的损伤机制；并发硬膜外或硬膜下出血；以及意外死亡方式。相比之下，在 dTAI-病例中至少有两倍于 dTAI+病例的因素有：受伤后存活时间短（<30 分钟）；并发脑内/脑室出血或挫伤；小脑蚓部萎缩；以及自然或故意杀人死亡方式。本研究揭示了当今法医尸检材料中 dTAI+和 dTAI-病例在环境特征和神经病理学发现方面的差异。典型病例特征的数据可能有助于不仅在法医尸检中，而且在头部受伤的存活患者中估计 dTAI 的先验概率。
