FORENSIC MEDICAL ANALISYS OF THE CLOSED HEAD ACCELERATION-DECELERATION INJURIES

Abstract

Abstract: Closed head injuries have been already classified on contact injuries and acceleration-deceleration injuries. Two typical acceleration-deceleration injuries are acute subdural hematoma (ASDH) and diffuse axonal injury (DAI), which are characterized with high mortality and that is where they got their medico-legal importance. Using experiments, it has been shown that acceleration with an impact time of more than 20-25 ms (which occurs in traffic accidents in real life) causes diffuse axonal injury, whereas an impact time of 5-10 ms is more likely to produce acute subdural hematoma. The aim of this research is to show that some types of traffic accidents are more typical for the occurrence of DAI, as well as that the typical mechanism for the occurrence of ASDH is fall on a firm surface. The study has been conducted on 80 forensic autopsy cases with closed head injuries (traffic accidents, falls and assaults) where additionally to a complete forensic medical autopsy, a complete forensic-neuropathological examination has been undertaken. For the purpose of diagnosing DAI, immunohistochemistry using antibody against ß-amyloid precursor protein has been involved. Results show that ASDH is more likely to occur in cases of simple fall, assaults and cyclists and DAI is more typical for vehicular traffic accidents and cases of falling from a considerable height. The paper also comprises discussion about some open questions regarding the diagnosis of diffuse axonal injury in the medico-legal practice.