The use of clinical CCT images in the forensic examination of closed head injuries

Abstract

The forensic evaluation of clinical cranial computed tomographies (CCT) frequently is the only reliable source of morphological evidence in head injuries when the injured individual survives or when death is delayed and autopsy findings are characterized by secondary changes. We have reviewed 21 cases where clinical CCT examinations were used to establish a medico-legal diagnosis. In 18 cases falls ( n=13) could be distinguished from blows ( n=5) due to the presence and/or absence of coup and contrecoup lesions and linear or depressed skull fractures. In two cases the striking object could be identified by digital superimposition. The minimum number of blows could be determined in 1 case. Only in 3 remaining cases the results were inconclusive. In our experience, CCT scans provide an important source of information for the forensic expert. To have unbiased access to these information, it is useful to evaluate the CT scans personally which requires a basic knowledge of traumatic changes found on radiographs.