2.10. Racking the brain! Cerebral edema on postmortem computed tomography compared to forensic autopsy

Abstract

Objective Cerebral swelling is a typical finding on postmortem computed tomography (PMCT). Detection of pre-existing brain edema despite normal postmortem changes is merely based on visual judgment, dependent on the investigator׳s experience, as there are no standards yet. The purpose of this study was to evaluate the diagnostic reliability in differentiation between of pre-existing cerebral edema and physiological postmortem brain swelling on PMCT compared to forensic autopsy and to establish diagnostic criteria for intoxication or asphyxia as cause of death. Methods and materials The study collective included 200 deceased (142 males and 58 females), ranging from 20–88 years. In retrospect 109 cases (out of 200 deceased) were evaluated regarding the following parameters: tonsillar herniation, the width of the outer and inner cerebrospinal spaces and by Hounsfield (HU) measurements of the gray and white matter related to the distinct age groups and causes of death. Results were compared to the findings of subsequent autopsy as gold standard for diagnosing cerebral edema. Results Cerebral edema (despite normal postmortem swelling) can be assessed reliable by PMCT based on narrowed temporal horns and with symmetrical herniation of the cerebral tonsils ( p p 20 HU and the grey to white matter ratio (GWR) was higher than >1.58. Conclusion Generalized brain edema despite normal postmortem changes can be differentiated on PMCT and white and grey matter HU measurement helps to determine the cause of death in cases of intoxication or asphyxia.