The Autopsy in Fatal Non-Missile Head Injuries

Abstract

The identification and interpretation of brain damage resulting from a non-missile head injury is often not easy — if only because the most obvious structural damage identified post mortem may not be the most important. There must be many occasions when death is certified as being due to fracture of the skull and cerebral contusions when neither may have even been the reason for the patient having been unconscious. Patients with a fracture and quite severe contusions can make an uneventful and complete recovery from their injury if no other types of brain damage are present (cf. Figs. 7 and 9). The aim of this chapter therefore is to advise on a pragmatic approach to the autopsy, to define clearly the various types of brain damage that may occur, and to remind the pathologist that he must know what he is looking for. This is particularly important when there is no evidence of severe cerebral contusions or of a large intracranial haematoma. A patient may die as a result of a non-missile head injury without either of these being present. Thus a systematic approach is required, and the pathologist must be aware of the more subtle — and often most important — types of brain damage that can occur in a patient who sustains a non-missile head injury. Frequently the damage can be identified only microscopically.