[Forensic medical aspects of intracranial hemorrhage]

Intracranial haemorrhage may be due to pathological processes or trauma even in the absence of a fracture. Since the circumstances surrounding death in such cases are often obscure, the police are notified and a forensic autopsy is performed.

We have retrospectively analysed 116 cases (66 males and 50 females) of intracranial haemorrhages without a concomitant fracture occurring in a series of 4,040 forensic autopsies.

Intracerebral haemorrhage was most frequently encountered (46%), while subarachnoidal haemorrhage occurred in 38 cases (32.8%), of which only 27 (71%) had aneurysms. In two cases, traumatic subarachnoidal haemorrhage occurred after a fight. Subdural haematomas were found in 24 cases (21%); they were significantly more frequent among men than among women. Intracerebral haemorrhage was often associated with cardiac hypertrophy, while subdural haematomas were strongly associated with alcohol abuse and falls. Intracerebral bleeding in the younger age group was related to arteriovenous malformations, abuse of heroin or amphetamine. In the majority of cases, the haemorrhage occurred at home. In 21 cases there was information about accidents, mainly falls. Eight cases were later brought to court and the perpetrator charged with manslaughter or murder. Hospital admission occurred in 18% of the cases; only half of the patients underwent surgery and died from cerebral complications.

This investigation underlines the importance of performing a forensic autopsy in fatalities with head injury or intracranial haemorrhage in order to specify the type of bleeding and possible aetiological factors involved.