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Analysis of different post mortem assessment methods for cerebral edema.
Melanie Bauer1, Kathrin Gerlach1, Eva Scheurer1
1Institute of Forensic Medicine, Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Institute of Forensic Medicine, Health Department Basel-Stadt, Basel, Switzerland.
Forensic Science International
|February 5, 2020
Summary
Postmortem cerebral edema assessment can be challenging. A new method using normalized cerebral weight offers an objective, quantitative classification, showing excellent agreement with macroscopic evaluations by forensic pathologists.
Area of Science:
- Forensic Pathology
- Neuropathology
- Medical Imaging
Background:
- Cerebral edema, a life-threatening condition in living individuals, can also manifest as fluid redistribution postmortem.
- Current postmortem assessment relies on macroscopic signs, lacking quantitative objectivity.
- Existing quantitative methods show poor agreement with macroscopic edema evaluation.
Purpose of the Study:
- To compare existing quantitative methods for cerebral edema assessment with macroscopic evaluations.
- To develop a more objective and reliable quantitative method for classifying postmortem cerebral edema.
- To investigate factors influencing postmortem cerebral edema classification.
Main Methods:
- Comparison of a mathematical formula (Radojevic et al., 2017) using intracranial dimensions and cerebral weight with macroscopic signs in 31 cases.
- Calculation of normalized cerebral weight (cerebral weight relative to intracranial volume) in 115 cases.
- Analysis of the influence of postmortem time, cooling time, and age at death on edema classification.
Main Results:
- Existing measurement methods showed excellent inter-rater and measurement agreement but poor agreement with macroscopic edema evaluation.
- Normalized cerebral weight demonstrated excellent agreement with macroscopic ratings.
- A clear numerical distinction was observed between edematous and non-edematous groups using normalized cerebral weight.
- Postmortem and cooling times had negligible effects, while age at death could confound results due to cerebral atrophy.
Conclusions:
- Normalized cerebral weight provides a rater-independent, objective, and quantitative method for classifying postmortem cerebral edema.
- This new method is as reliable as the subjective macroscopic assessment by forensic pathologists.
- The findings offer a more consistent approach to diagnosing postmortem cerebral edema.
