Abstract
This paper aims to demonstrate that post-mortem CT (PMCT) can locate intracranial hemorrhages, even in decomposed cases. This is of relevance in that post-mortem decomposition is particularly damaging to the brain tissue’s consistency, resulting in great difficulties to reliably diagnose and locate intracranial hemorrhages. We searched our case database of the last 11 years to find cases with decomposition of the body, where PMCT and an autopsy had been performed. We identified eleven cases according to these criteria. Postmortem interval ranged from 2 days to 2 weeks, and post-mortem radiological alteration index (RAI) was at or above 49. Eight out of eleven cases showed an intraparenchymal hemorrhage whereas the hemorrhage was extra-axial in the remaining three cases. Autopsy validated the presence of intracranial hemorrhage in all eleven cases, but location could not be confirmed due to liquid state of the brain. PMCT identified and localized intracranial hemorrhages in decomposed bodies, and in all of these cases, autopsy validated their presence. The actual cause of the hemorrhage (e.g. tumor, metastasis, vascular malformation, hypertensive hemorrhage) remained obscure. From this case series, it can be concluded that PMCT may add relevant information pertaining to localization of intracranial hemorrhages in decomposed bodies.
Highlights
Detection and specification of intracranial hemorrhages are an important part of an examination, before establishing a cause of death [1]
Putrefaction reduces the examiner’s capability to provide sufficient diagnostic distinction between fall or blow related hemorrhages when compared to the consequences of a hypertensive mass hemorrhage
Autopsy may still allow the identification of reddish discoloration of the liquefied brain, but localization of this discoloration may be difficult or impossible
Summary
Detection and specification of intracranial hemorrhages are an important part of an examination, before establishing a cause of death [1]. Discriminating intraparenchymal hemorrhages [2] from extra-axial hemorrhages [3, 4] appears to be relevant with regard to manner of death, in that identifying a mass hemorrhage or subdural bleeding has different consequences for the way a case is subsequently undertaken. Identifying a natural cause of death in an initially suspicious or unclear situation may defuse the pressure on the investigating authorities and allow them to release the body and the secured premises [5, 6]. Autopsy may still allow the identification of reddish discoloration of the liquefied brain, but localization of this discoloration may be difficult or impossible. Performing postmortem imaging prior to opening the skull has been found to be helpful, in these instances [8]
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