Head injuries associated with forensic medicine and intracrnial bleedig, firearm injuries, blast injuries and post mortum changes

1. Fixed Learning Session - 3
Intracranial injuries…
Firearm & Blast injuries…
Postmortem changes…

2. Objectives…
You should utilize this FLS to achieve the following;
 Intracranial injuries
Identify the different features and causation of injuries.
• Fire arm
Identify the injuries caused by different types of fire arm.
Identification of entry and exit wound
Identify circumstances of firearm injury
• Postmortem changes
Identify the different types of postmortem changes at
different time intervals.

3. Intracranial Injuries…
The brain, its membranes and blood vessels are said to be
the most fragile of all the organs of the body. That is why
they are encased in a rigid bony box called the skull.
Intracranial injuries include injury to the above soft tissues.

4. Objectives…
You should utilize this FLS to achieve the following;
 Intracranial injuries
Identify the different features and causation of
injuries.

5. Case Scenario…
A 25 yr old pedestrian was knocked down by a car and
thrown onto the road. She was admitted to the ward in
unconscious state.

6. 1. List the possible types of
intracranial haemorrhages
that may be observed in a
patient with head injury.

7. 1. List the possible types of
intracranial haemorrhages
that may be observed in a
patient with head injury.
1. Extradural haemorrhage
(EDH)
2. Subdural haemorrhage (SDH)
3. Subarrachnoid haemorrhage
(SAH)
4. Intracerebral haemorrhage
(ICH)

8. 2. Identify the lesion seen in
this photograph.

9. 2. Identify the lesion seen in
this photograph.
Diffuse subarachnoid haemorrhage
(SAH) over the cerebral
hemispheres
This subarachnoid haemorrhage
has resulted from rupturing of
bridging vessels during rotation of
the brain.

10. 3. What are the other
possible causes for SAH?

11. 4. What are the other
possible causes for SAH?
Extension of traumatic
intracerebral haemorrhage
Rupture of Berry aneurysm
Rupture of the AV malformation
Rupture/laceration of vertebral
artery

12. Case Scenario…
A patient who had a severe headache was admitted to the
medical ward in an unconscious state. He was a
hypertensive patient. Following abnormalities were
detected during the autopsy.

13. 1. Identify the abnormality
pointed by the arrow.

14. 1. Identify the abnormality
pointed by the arrow.
Ruptured berry aneurysm

15. 2. What is the type of
intracranial haemorrhage you
would expect to see in this
person?

16. 2. What is the type of
intracranial haemorrhage you
would expect to see in this
person?
Basal subarchnoid haemorrhage

17. 3. What is the most likely
mechanism of death?

18. 3. What is the most likely
mechanism of death?
Basal subarachnoid haemorrhage
causes vide spread vascular spasm
which may have an effect on vital
centers of the brain stem causing
sudden collapse and death.

19. Case Scenario…
A 40yr old man was assaulted with a wooden pole over the
right side of the head. On examination there was a
laceration over the right temporo-parietal region. The Xray
of the skull showed an underlying fracture. Despite the
medical intervention the patient succumbed to the injuries.

20. 1. Identify the intracranial
haemorrhage shown by this
photograph.

21. 1. Identify the intracranial
haemorrhage shown by this
photograph.
Extra dural haemorrhage

22. 2. Name the responsible
blood vessel causing above
haemorrhage.

23. 2. Name the responsible
blood vessel causing above
haemorrhage.
Middle meningeal artery

24. 3. Describe the clinical
picture of this person.

25. 3. Describe the clinical
picture of this person.
Lose of conciseness due to concussion
Followed by recovery and “lucid
interval”
Gradual decoration of the level of
consciousness

26. Fact file…
Intracranial Haemorrhages…

27. Extradural haemorrhage…
(EDH)
This is the collection of blood
between the skull and dura mater .
Since the dura is closely applied to
the skull in the base it does not occur
on the base except on the posterior
fossa.
Most extradural haemorrhages are
associated with skull fractures.

28. Extradural haemorrhage…
(EDH)
The classical clinical sign of
extradural haemorrhage includes
‘lucid interval’.
A doctor may be accused of medical
negligence if a patient is discharged
from the hospital after the recovery of
the concussion and died at home
from complications of extradural
haemorrhage.

29. Subdural haemorrhage…
(SDH)
This is collection of blood in the
sudural space and it is much more
common than extradural
haemorrhage.
It can be classified in to acute and
chronic and commoner in both
extremes of life.

30. Subdural haemorrhage…
(SDH)
In young it is infamously associated
with fatal child abuse.
Acute SDH is a common result of any
significant head injury. Majority of
SDH are associated with skull
fractures.

31. Subarachnoid haemorrhage…
(SAH)
This is collection of blood in the
subarachnoid space.
The blood in the subarachnoid space
tend to mix with CSF. Therefore
unlike other haemorrhage less likely
to clot.

32. Subarachnoid haemorrhage…
(SAH)
SAH can also occur as a result of
natural causes such as rupture of
berry aneurysm and arterior-venous
malformations.
Death from SAH may be
instantaneous, particularly when
there is haemorrhage around the
brainstem.

33. Intracranial haemorrhage…
(ICH)
They can be either infiltrating brain
tissue or forming actual
haematoma in the brain tissue.
Primary haemorrhages occur at the
time of injury due to rupture of
blood vessels.
Secondary haemorrhage occur due
to the injured area undergoing
swelling, softening, liquefaction,
and cavity formation .
The ruptured vessels at the margins
bleeds into the cavity.

34. Firearm Injuries…
A firearm is any instrument which discharges a missile by
the expansive force of the gases produced by burning of an
explosive substance.
Forensic Ballistics is the science dealing with the
investigation of firearms, ammunition and the problems
arising from their use.

35. Objectives…
You should utilize this FLS to achieve the following;
• Fire arm
Identify the injuries caused by different types of fire
arm
Identification of entry and exit wound
Identify circumstances of firearm injury

36. Fact file…
There are 2 types of firearms…

37. 2 types of firearms…
Rifle Smooth bore

38. Case Scenario…
A 50yr old male who was later revealed to be a leader of a
local drug dealing gang was found dead at a junction of a
road. There were multiple firearm injuries on the body of
the victim. The victim was found to be shot from
intermediate range.

39. 1. How would you identify the type of firearm by examining the injuries ?
A
B

40. 1. How would you identify the type of firearm by examining the injuries?
Rifle (A) Smooth bore (B)
Edge of the
wound
Circular hole with inverted
margins
Scalloped edges (rat hole)
Satellite wounds Absent Present
Wad mark Absent Present as a
laceration/contusion below
the main wound but not
visible in this case
Abrasion collar Present Absent
Grease ring Present Absent

41. Case Scenario…
A 20yr old male was shot during a police raid. He was
admitted to a surgical unit and the MO medico legal was
summoned to do medico-legal examination of the patient.
Eye witness reported that the man was shot by a rifle.

42. 1. What are the features that would help the MO medico-legal to
differentiate an entry wound from an exit wound?
A B

43. 1. What are the features that would help the MO medico-legal to
differentiate an entry wound from an exit wound?
Entry wound (A) Exit wound (B)
Shape Circular hole with inverted
margins
Stellate and everted
Abrasion collar Present Absent
Burning
Blackening
Tattooing
May be present depending on
the range of fire but not
present in this case
absent

44. Case Scenario…
A 35yr old male was found dead inside a room with a
circular laceration on the forehead.

45. 1. Which of the following features will indicate this case as a firearm suicide?
1. Room is locked from inside.
1. Weapon is absent from the scene.
1. Presence of more than one fatal injury.
1. Elective site.
1. Entry wound is compatible with the handedness.
1. Injuries present in inaccessible area.

46. 1. Which of the following features will indicate this case as a firearm suicide?
1. Room is locked from inside. (T)
1. Weapon is absent from the scene. (F)
1. Presence of more than one fatal injury. (F)
1. Elective site. (T)
1. Entry wound is compatible with the handedness. (T)
1. Injuries present in inaccessible area. (F)

47. Postmortem changes…
The underlying biological processes that a human body or
its remains undergo after death are called postmortem
changes. There is a broad range of variables influencing
postmortem changes by alteration of underlying process of
tissue destruction. Understanding the resultant postmortem
changes is of great importance to forensic pathologist.

48. Objectives…
You should utilize this FLS to achieve the following;
• Postmortem changes
Identify the different types of postmortem changes at
different time intervals.

49. Early postmortem changes…
Include;
•Rigor mortis
•Hypostasis
•Dilation of pupils
•Dropping of intraocular pressure
•Loss of skin elasticity

50. Case Scenario…
The body of a 27yr old adult male was found inside a motor
car with a running engine. Following picture was taken
during the autopsy.

51. 1. What could be the likely
cause of death?

52. 1. What could be the likely
cause of death?
CO poisoning

53. 2. How would you confirm
your diagnosis?

54. 2. How would you confirm
your diagnosis?
Venous blood sample for CO level from
femoral vein

55. Fact file…
The colour of hypostasis may indicate the cause of death…

56. Different colours of hypostasis…

57. Case Scenario…
A body of a 20 year old male was recovered from a river.
Following photograph was taken during the autopsy.

58. 1. Identify the postmortem
change seen in this
photograph.

59. 1. Identify the postmortem
change seen in this
photograph.
Cadaveric spasm
Cadaveric/Postmortem spasm is a
form of muscular stiffening that
occurs at the time of death
persisting into the period of rigor
mortis. It is usually associated
with violent deaths with intense
emotion.

60. 2. What is the medico-legal
significance of this?

61. 2. What is the medico-legal
significance of this?
It provides a clue that the
individual was alive at the time of
entering into the water.

62. Case Scenario…
A 70 year old man who was living alone was found dead by
the neighbors.

63. 1. Identify the postmortem changes.

64. 1. 1. Identify the postmortem
changes
Skin blisters
Skin slippage
Bloating of the body
Colour change of the skin

65. 1. Depending on the
postmortem changes roughly
estimate the time since
death.

66. 1. Depending on the
postmortem changes roughly
estimate the time since
death.
Time since death 48-72 hours

67. Late postmortem changes…
Include;
•Mummification
•Adipocere formation
•Skeletalization

68. Case Scenario…
A body of a six (6) months old infant was exhumed for
autopsy following allegations by relatives.

69. 1. Identify the postmortem
change seen in this
photograph.

70. 1. Identify the postmortem
change seen in this
photograph.
Adipocere formation
This is a rare phenomenon.
The fat coverage of the
body hydrolyse and
hydrogenases.
This forms a greyish white,
greasy, friable substance
with cheesy amonical smell.
The time of onset is highly
variable and is between 1-
6/12.

71. 2. What is the environmental
condition that is favourable
for this .

72. 2. What is the environmental
condition that is favourable
for this .
Warm and moist environment

73. 2. List the important medico-legal
significances of this
change.

74. 2. List the important medico-legal
significances of this
change.
• Condition of disposal
• Preserve external features
• Identification of injuries
• Time since death : Minimum 3 -6
wks

75. Case Scenario…
A body of an adult male was recovered from a desert like
place. He went missing from home four (4) weeks ago.

76. 1. Identify the postmortem
change seen in this
photograph.

77. 1. Identify the postmortem
change seen in this
photograph.
Mummification
Needs hot dry and windy condition.
Commonly seen in deserts.
Tissues will dry and shrivelled
preventing putrefaction. This
results in stretching the skin. The
condition may co –exists with
adipocere.

78. 2. List the important medico-legal
significances of this
change.

79. 2. List the important medico-legal
significances of this
change.
• Condition of disposal
• Identification
• Identification of injuries
• Time since death - 2 - 4 wks

80. Identify the given
postmortem artifact and click
on the correct answer.
Rat bites
Ant bites
Fish bites
Predator attacks

81. Correct!
Click here for the
explanation.

82. Wrong Answer.
Click here for the
explanation.

83. Postmortem ant bites…
Ants can be present at all stages of
decomposition as they are typically
observed shortly after death or during
the early postmortem period.
The feeding action of ants can cause
many irregular scalloped areas of
superficial skin loss, and small punctuate
and scratch-type lesions with well
defined margins.
Usually ant injuries are orange-pink to
yellow in color and diffusely scattered
over the skin surface.
These injuries can be easily
misinterpreted as antemortem abrasions
but the absence of inflammatory
reactions helps to differentiate them
from antemortem injuries.

84. Identify the given
postmortem artifact and click
on the correct answer.
Rat bites
Ant bites
Fish bites
Predator attacks

85. Correct!
Click here for the
explanation.

86. Wrong Answer.
Click here for the
explanation.

87. Predator attacks…
There are multiple parallel claw
marks with no vital reactions
probably inflicted by a water
monitor.

88. Now can you?
 Identify the different features and causation of injuries.
• Identify the injuries caused by different types of fire arm.
• Identify the different types of postmortem changes at
different time intervals.