Laakko Essi, Oura Petteri
Department of Forensic Medicine, University of Helsinki, P.O. Box 21, FI-00014, Helsinki, Finland.
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.
J Forensic Leg Med. 2025 May;112:102866. doi: 10.1016/j.jflm.2025.102866. Epub 2025 Apr 1.
Neurodegenerative diseases present diagnostic challenges due to their diverse clinical presentations, which emphasizes the importance of postmortem neuropathological examination. As neurodegenerative diseases become more common with age, they contribute to a higher risk of falls, accidents and head injuries. Our aims were to, first, report the prevalence of neurodegenerative disease findings in Finnish neuropathologically examined medico-legal autopsy cases with acute head injuries and, second, report the prevalence, injury circumstances, and types of specific brain injuries in the most common disease entities. We analyzed cases from the Helsinki office of the Forensic Medicine Unit, Finnish Institute for Health and Welfare, over the period 2016-2022. Cases were included if they had a suspected or confirmed head injury, and underwent a full neuropathological examination with neurodegenerative immunohistochemistry. Data on background characteristics, neurodegenerative immunostains and diagnoses, and head injuries were collected from cause-of-death investigation documents and neuropathology reports. Prevalences of neurodegenerative diagnoses were calculated, and head injury findings were presented for the most common disease entities. During the study period, there were a total of 128 neuropathologically examined cases with suspected or confirmed acute head injuries. Neurodegenerative immunohistochemistry was performed in 57 of them, and a neurodegenerative diagnosis was established in 47 cases. The most prevalent diagnoses were Alzheimer's disease neuropathologic change (ADNPC) (n = 34), cerebrovascular disease (CVD) (n = 34) and Lewy body disease (LBD) (n = 9). Old head injuries were common among cases with any neurodegenerative diagnosis (36.2 %). Of specific findings, subdural haemorrhage and hypoxic-ischaemic neuronal injury had the highest absolute prevalence in cases with ADNPC, although there were no major differences between ADNPC, CVD and LBD. In conclusion, the most prevalent neurodegenerative disease entities in this dataset were ADNPC, CVD and LBD. A history of head injuries was common regardless of the neurodegenerative entity.
神经退行性疾病因其多样的临床表现而带来诊断挑战，这凸显了尸检神经病理学检查的重要性。随着神经退行性疾病随着年龄增长变得更加常见，它们导致跌倒、事故和头部受伤的风险更高。我们的目的，首先是报告在芬兰经神经病理学检查的急性头部受伤的法医学尸检病例中神经退行性疾病发现的患病率，其次是报告最常见疾病实体中的患病率、损伤情况和特定脑损伤类型。我们分析了芬兰健康与福利研究所法医学部赫尔辛基办公室在2016年至2022年期间的病例。如果病例有疑似或确诊的头部损伤，并接受了包括神经退行性免疫组织化学在内的全面神经病理学检查，则纳入研究。从死因调查文件和神经病理学报告中收集有关背景特征、神经退行性免疫染色和诊断以及头部损伤的数据。计算神经退行性诊断的患病率，并列出最常见疾病实体的头部损伤发现。在研究期间，共有128例经神经病理学检查的疑似或确诊急性头部损伤病例。其中57例进行了神经退行性免疫组织化学检查，47例确诊为神经退行性疾病。最常见的诊断是阿尔茨海默病神经病理改变（ADNPC）（n = 34）、脑血管疾病（CVD）（n = 34）和路易体病（LBD）（n = 9）。在任何神经退行性诊断的病例中，陈旧性头部损伤都很常见（36.2%）。在特定发现中，硬膜下出血和缺氧缺血性神经元损伤在ADNPC病例中的绝对患病率最高，尽管ADNPC、CVD和LBD之间没有重大差异。总之，该数据集中最常见的神经退行性疾病实体是ADNPC、CVD和LBD。无论神经退行性疾病实体如何，头部受伤史都很常见。
