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Subdural Hemorrhage, a Retrospective Review with Emphasis on a Cohort of Alcoholics
Stephen J deRoux1, Anthony Sgarlato2
1New York City Office of Chief Medical Examiner and Department of Forensic Medicine, New York University School of Medicine, New York, 10016, NY.
Insights
Subdural hemorrhage (SDH) is a significant cause of death, particularly in alcoholics. Autopsies are crucial for detecting SDH in alcoholics, especially when the cause of death is unclear.
Area of Science:
- Forensic Pathology
- Neurology
- Toxicology
Background:
- Subdural hemorrhage (SDH) is a frequent cause of mortality.
- External signs of injury may be absent, necessitating autopsy for diagnosis.
- Alcohol abuse is prevalent and associated with increased risk of injury.
Purpose of the Study:
- To review cases of subdural hemorrhage (SDH) over three years.
- To focus on the prevalence of SDH in a cohort of alcoholic individuals.
- To assess the need for autopsy in alcoholic deaths with unclear causes.
Main Methods:
- Retrospective review of 1942 cases from the New York City Office of Chief Medical Examiner.
- Analysis of 1588 alcoholic individuals within the study population.
- Examination of autopsy and imaging data for cases of SDH.
Main Results:
- Subdural hemorrhage (SDH) was identified in approximately 8% of alcoholic individuals (26% of all SDH cases).
- Among alcoholics with SDH, 57% had associated brain injuries.
- A concerning 6% of alcoholics lacked autopsy or imaging, potentially obscuring inflicted injuries.
Conclusions:
- Alcoholic individuals represent a significant proportion of subdural hemorrhage (SDH) cases.
- The absence of autopsy in some alcoholic deaths may lead to missed diagnoses of SDH.
- Routine autopsy is recommended for alcoholics with undetermined causes of death to identify potential subdural hemorrhages.
Abstract:
Subdural hemorrhage (SDH) is a common cause of death. As external evidence of injury may be absent, an autopsy is frequently needed to detect it. We conducted a 3-year review of SDH from the New York City Office of Chief Medical Examiner, with emphasis on a cohort of alcoholics. Our study population of 1942 included 1588 alcoholics. Of the alcoholics, c. 8% had SDH (26% of the total number of SDH). Of the alcoholics with SDH, 57% had associated brain injuries. As alcohol intoxication is frequently associated with aggressive and violent behavior, we are concerned that 6% of alcoholics in our review had no autopsy or imaging studies. It is possible that a portion of these may have had a SDH due to an unrecognized inflicted injury. We recommend that autopsies be performed on all alcoholics without a clear cause or mechanism of death.
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