Narayan Gaia, Oura Petteri
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.
Int J Legal Med. 2025 May;139(3):1335-1342. doi: 10.1007/s00414-025-03415-3. Epub 2025 Jan 21.
In forensic neuropathology, the β-amyloid precursor protein (β-APP) immunostain is used to diagnose axonal injury (AI). The two most common aetiologies are traumatic (TAI) and ischaemic (vascular; VAI). We aimed to identify background characteristics and neuropathology findings that are suggestive of TAI, VAI, or no AI in neuropathologically examined medico-legal autopsy cases. The dataset comprised 166 cases from Finland over the period 2016-2023. The diagnosis of AI was based on β-APP stain (TAI, VAI, or no AI). Data on background characteristics and neuropathology findings were collected from cause-of-death investigation documents. Prevalence ratios were calculated for each variable to enable comparisons between the AI categories. The sample were 71.7% males; median age was 41 years (range 0-96). There were 26 cases with TAI, 44 with VAI, and 96 with no AI. The variables that showed statistical significance and had at least two-fold prevalence among TAI cases compared to VAI cases were: a documented recent injury; and presence of any extracranial/cranial/intracranial injury (including subdural haemorrhage [SDH], subarachnoid haemorrhage [SAH], intracerebral/ventricular haemorrhage [ICVH], or contusion) in autopsy or neuropathology. Correspondingly, variables indicating TAI over no AI were: a documented recent injury; postinjury survival ≥ 24 h; and presence of any extracranial/cranial/intracranial injury (including SDH, SAH, ICVH, contusion), herniation, or infarction in autopsy or neuropathology. Postinjury survival < 30 min was identified as an indicator of no AI over TAI. Finally, variables indicating VAI over no AI were: postinjury survival ≥ 24 h; lack of external injury to the head; and presence of SDH, brain oedema, herniation, or infarction in autopsy or neuropathology. In conclusion, we report several differences in characteristics and findings between cases diagnosed with TAI, VAI, and no AI. Our findings may help estimate the likelihood and potential aetiology of AI based on background characteristics and other neuropathology findings.
在法医神经病理学中，β-淀粉样前体蛋白（β-APP）免疫染色用于诊断轴突损伤（AI）。两种最常见的病因是创伤性（TAI）和缺血性（血管性；VAI）。我们旨在确定在经神经病理学检查的法医学尸体解剖病例中，提示TAI、VAI或无AI的背景特征和神经病理学发现。该数据集包括2016年至2023年期间来自芬兰的166例病例。AI的诊断基于β-APP染色（TAI、VAI或无AI）。从死因调查文件中收集背景特征和神经病理学发现的数据。计算每个变量的患病率比，以便在AI类别之间进行比较。样本中男性占71.7%；中位年龄为41岁（范围0 - 96岁）。有26例TAI、44例VAI和96例无AI。与VAI病例相比，在TAI病例中显示出统计学意义且患病率至少高出两倍的变量为：有记录的近期损伤；以及在尸检或神经病理学检查中存在任何颅外/颅骨/颅内损伤（包括硬膜下出血[SDH]、蛛网膜下腔出血[SAH]、脑内/脑室内出血[ICVH]或挫伤）。相应地，提示TAI而非无AI的变量为：有记录的近期损伤；伤后存活时间≥24小时；以及在尸检或神经病理学检查中存在任何颅外/颅骨/颅内损伤（包括SDH、SAH、ICVH、挫伤）、脑疝或梗死。伤后存活时间<30分钟被确定为无AI而非TAI的一个指标。最后，提示VAI而非无AI的变量为：伤后存活时间≥24小时；头部无外部损伤；以及在尸检或神经病理学检查中存在SDH、脑水肿、脑疝或梗死。总之，我们报告了诊断为TAI、VAI和无AI的病例在特征和发现方面的几个差异。我们的发现可能有助于根据背景特征和其他神经病理学发现来估计AI的可能性和潜在病因。
