By Dr. Enas Mohamed Ameen Demonstrator of forensic medicine & clinical toxicology

1. Head Injuries By Dr. Enas Mohamed Ameen Demonstrator of forensic medicine & clinical toxicology

2. How to Comment on Forensic specimen

3. -Diagnosis -Presenting part -Description of the lesion -Causative agent + Mechanical cause (if present) -Complications -Cause of Death

4. Head Injuries -Scalp injuries -Facial injuries -Fractures of the Skull -Intracranial injuries

5. Scalp injuries

6. Anatomy of the scalp

7. Anatomy of the skull & meninges

9. Diagnosis:Lacerations of the Scalp -Presenting part ( Scalp + Face) -Description of the lesion .simulating cut wound ( Blunt trauma split the skin & tissues into sharply-demarcated fashion) .Close examination using a lens ( Bruised edges, hairs cross within the wound, tissue bridges , small nerves & vessels within the depth) -Causative agent (Blunt trauma) -Complications . Infection (spread via emissary veins or fissure to interior of the skull causing meningitis, brain abscess, thrombosis of venous sinusis) .Hge (scalp rich in bood supply) . Associated brain injury .Concussion &post-concussion syndrome -M.L.I may reproduce pattern of inflicting weapon

10. Complications: Associated subdural Hge, subarachnoid He, cerebral laceration or contusion

14. Diagnosis:Cut wound of the Scalp Presenting part ( Scalp + Face) -Description of the lesion .regular clean cut edges .Close examination using a lens (hairs sharply cut, NO tissue bridges , NO small nerves & vessels within the depth, NO abrasions or bruises at the edges) -Causative agent (heavy sharp object) -Complications . Infection (spread via emissary veins or fissure to interior of the skull causing meningitis, brain abscess, thrombosis of venous sinusis) .Hge (scalp rich in bood supply) . Associated brain injury .Concussion &post-concussion syndrome -M.L.I may reproduce pattern of inflicting weapon

16. Skull Fractures

18. Complication: post-traumatic epilepsy as mesodermal scarring of cortex irritate the brain (if infection occurred) M.L.I: may reproduce pattern of inflicting weapon & where it 1st strikes

19. Presenting part ( skull) -Description of the lesion .fracture -Causative agent (blunt impact) -Mechanics: FOCAL IMPACT-MOMENTARY DISTORTION OF THE SHAPE OF CRANIUM->INTRUSION & EXTRUSION AREAS->IIF DISTORTION EXCEEDS ELASTICITY -> FRACTURE AT INTRUDED & EXTRUDED AREAS -Complications . Infection (spread via –direct spread in compound fracture infected scalp injuries, nasal cavity , paranasal sinuses causing meningitis, brain abscess, thrombosis of venous sinusis) .extraduralHge (if crack passes through embedded meningeal artery) . Associated brain injury .Concussion &post-concussion syndrome -Cause of death .Immediate: fatal concussion, brain laceration, compression .delayed: sepsis , epilepsy

20. Black Eye • D.D -Direct violence -Gravitational movement of blood beneath ant. Scalp from a hematoma or bruise -fracture base ( ant. Fossa)

21. Nose -> ant fossa ear-> middle fossa

23. Meninges

24. Dura Arachnoid Pia

26. Extradural Hge Bleeding between inner surface of skull & dura Presenting part ( brain) -Description of the lesion . Extradural hge -Mechanical cause .Rupture of middle meningeal a. transected by fracture line Leakage of high pressure arterial blood strips back dura with progressive accumulation of hematoma . Torn venous sinuse -Complications .Concussion &post-concussion syndrome .Compression .Herniation .Neurological sequelea (retrograde amnesia, post-traumatic neurosis, epilepsy, sepsis, perminant infirmity. Aphasia if lt. frontal lobe involved broca’s area) -Cause of death : fatal concussion, compression, brain laceration , intracranial sepsis , epilepsy) -M.L.I: IF DISCHARGED and death occurs ( negligence against unsuspecting doctor))

28. Chronic Subdural Hge Bleeding beneath the dura Presenting part ( brain) -Description of the lesion . Chronic subdural he (describe) -Mechanical cause .repeated minor trauma -Complications .Concussion &post-concussion syndrome .Compression( ++ ICT) due to ++ size of hematoma .Herniation & DAMAGE TO VITAL centers in brainstem .Neurological sequelea (dementia, neurosis, epilepsy, sepsis,. Deterioration of concious level) -Cause of death : fatal concussion, compression, herniation , associated brain laceration , intracranial sepsis , epilepsy) -

30. Intracerebral Hge Presenting part ( brain cerebral hemishere) -Description of the lesion . Intracerebralhge ( DESCRIBE)) -Mechanical cause .due to natural causes as hypertension or trauma (from branches of middle cerebral a.) -Complications .Concussion &post-concussion syndrome .Compression( ++ ICT) .Herniation & DAMAGE TO VITAL centers in brainstem .Neurological sequelea (dementia, neurosis, epilepsy, sepsis,. Deterioration of concious level) . Associated brain damage ( cerebral edema) -Cause of death : fatal concussion, compression, herniation , associated brain laceration , intracranial sepsis , epilepsy) --M.L.I: IF DISCHARGED and death occurs ( negligence against unsuspecting doctor))