Department of Forensic Medicine, University of Helsinki, P.O. Box 21, Helsinki FI-00014, Finland.
Forensic Medicine Unit, Finnish Institute for Health and Welfare, P.O. Box 30, Helsinki FI-00271, Finland.
Leg Med (Tokyo). 2024 Nov;71:102502. doi: 10.1016/j.legalmed.2024.102502. Epub 2024 Aug 2.
Primary head injury is often followed by secondary brain damage. However, the association between injury circumstances and the prevalence of secondary injuries remains unclear. We report the prevalence and association of secondary brain injuries with the circumstances in which a head injury was sustained. The sample comprised 76 neuropathologically examined medico-legal autopsy cases with an acute primary head injury. Neuropathology reports were analysed to determine the prevalence of various secondary injuries, i.e., hypoxic-ischaemic neuronal injury, brain oedema, and vascular axonal injury (VAI). The prevalences were compared between cases from three distinct injury circumstances, i.e., fall, assault, and strangulation. The sample had a median age of 49 years (interquartile range 27-73) and 71.1% were identified as male. As for distinct injury circumstances, the sample comprised 14 fall cases, 21 assault victims, and 6 strangulation victims. The prevalence of hypoxic-ischaemic neuronal injury was highest in strangulations (100.0%), followed by assaults (81.0%) and falls (64.3%); of specific brain regions, statistically significant differences between the three case groups were found in frontal and parietal cortex (p ≤ 0.018) and the hippocampus (p = 0.005). Brain oedema was present in approximately half of assault (47.6%) and strangulation cases (50.0%), contrastingly to the lower prevalence in falls (7.1%; p = 0.024). The prevalence of VAI appeared higher among assault (23.8%) and strangulation cases (16.7%) compared to falls (7.1%), but the differences were not statistically significant. We conclude that hypoxic-ischaemic neuronal injury and brain oedema were more prevalent among assault and strangulation cases compared to falls.
原发性头部损伤常继发继发性脑损伤。然而，损伤情况与继发性损伤的发生率之间的关系尚不清楚。我们报告了继发性脑损伤与头部损伤情况之间的发生率和关联。该样本包括 76 例经法医病理学检查的急性原发性头部损伤的医学法律案例。分析病理学报告以确定各种继发性损伤（即缺氧缺血性神经元损伤、脑水肿和血管轴索损伤（VAI））的发生率。将发生率在三种不同损伤情况下的病例进行比较，即跌倒、袭击和勒死。该样本的中位数年龄为 49 岁（四分位间距 27-73），71.1%为男性。至于不同的损伤情况，样本包括 14 例跌倒病例、21 例袭击受害者和 6 例勒死受害者。缺氧缺血性神经元损伤的发生率在勒死中最高（100.0%），其次是袭击（81.0%）和跌倒（64.3%）；在特定脑区，三组病例之间存在统计学显著差异在额皮质和顶皮质（p≤0.018）和海马体（p=0.005）。脑水肿约见于一半的袭击（47.6%）和勒死病例（50.0%），而跌倒的发生率较低（7.1%；p=0.024）。与跌倒（7.1%）相比，袭击（23.8%）和勒死病例（16.7%）中 VAI 的发生率似乎更高，但差异无统计学意义。我们的结论是，与跌倒相比，缺氧缺血性神经元损伤和脑水肿在袭击和勒死病例中更为常见。
