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By Dr. Enas Mohamed Ameen Demonstrator of forensic medicine & clinical toxicology.

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Presentation on theme: "By Dr. Enas Mohamed Ameen Demonstrator of forensic medicine & clinical toxicology."— Presentation transcript:

1 By Dr. Enas Mohamed Ameen Demonstrator of forensic medicine & clinical toxicology

2 How to Comment on Forensic specimen

3 -Diagnosis -Presenting part -Description of the lesion -Causative agent + Mechanical cause (if present) -Complications -Cause of Death

4 Head Injuries - Scalp injuries -Facial injuries -Fractures of the Skull -Intracranial injuries

5 Scalp injuries

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9 Diagnosis: Lacerations of the Scalp -Presenting part ( Scalp + Face) -Description of the lesion.simulating cut wound ( Blunt trauma split the skin & tissues into sharply-demarcated fashion).Close examination using a lens ( Bruised edges, hairs cross within the wound, tissue bridges, small nerves & vessels within the depth) -Causative agent (Blunt trauma) -Complications. Infection (spread via emissary veins or fissure to interior of the skull causing meningitis, brain abscess, thrombosis of venous sinusis).Hge (scalp rich in bood supply). Associated brain injury.Concussion &post-concussion syndrome -M.L.I may reproduce pattern of inflicting weapon

10 Complications: Associated subdural Hge, subarachnoid He, cerebral laceration or contusion

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14 Diagnosis: Cut wound of the Scalp Presenting part ( Scalp + Face) -Description of the lesion.regular clean cut edges.Close examination using a lens (hairs sharply cut, NO tissue bridges, NO small nerves & vessels within the depth, NO abrasions or bruises at the edges) -Causative agent (heavy sharp object) -Complications. Infection (spread via emissary veins or fissure to interior of the skull causing meningitis, brain abscess, thrombosis of venous sinusis).Hge (scalp rich in bood supply). Associated brain injury.Concussion &post-concussion syndrome -M.L.I may reproduce pattern of inflicting weapon

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16 Skull Fractures

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18 Complication: post-traumatic epilepsy as mesodermal scarring of cortex irritate the brain (if infection occurred) M.L.I: may reproduce pattern of inflicting weapon & where it 1 st strikes

19 Presenting part ( skull) -Description of the lesion.fracture -Causative agent (blunt impact) -Mechanics: FOCAL IMPACT-  MOMENTARY DISTORTION OF THE SHAPE OF CRANIUM- >INTRUSION & EXTRUSION AREAS->IIF DISTORTION EXCEEDS ELASTICITY -> FRACTURE AT INTRUDED & EXTRUDED AREAS -Complications. Infection (spread via –direct spread in compound fracture infected scalp injuries, nasal cavity, paranasal sinuses causing meningitis, brain abscess, thrombosis of venous sinusis).extradural Hge (if crack passes through embedded meningeal artery). Associated brain injury.Concussion &post-concussion syndrome -Cause of death.Immediate: fatal concussion, brain laceration, compression.delayed: sepsis, epilepsy

20 Black Eye D.D -Direct violence -Gravitational movement of blood beneath ant. Scalp from a hematoma or bruise -fracture base ( ant. Fossa)

21 Nose -> ant fossa ear-> middle fossa

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23 Meninges

24 Dura Arachnoid Pia

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26 Extradural Hge Bleeding between inner surface of skull & dura Presenting part ( brain) -Description of the lesion. Extradural hge -Mechanical cause.Rupture of middle meningeal a. transected by fracture line Leakage of high pressure arterial blood strips back dura with progressive accumulation of hematoma. Torn venous sinuse -Complications.Concussion &post-concussion syndrome.Compression.Herniation.Neurological sequelea (retrograde amnesia, post-traumatic neurosis, epilepsy, sepsis, perminant infirmity. Aphasia if lt. frontal lobe involved broca’s area) -Cause of death : fatal concussion, compression, brain laceration, intracranial sepsis, epilepsy) -M.L.I: IF DISCHARGED and death occurs ( negligence against unsuspecting doctor))

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28 Chronic Subdural Hge Bleeding beneath the dura Presenting part ( brain) -Description of the lesion. Chronic subdural he (describe) -Mechanical cause.repeated minor trauma -Complications.Concussion &post-concussion syndrome.Compression( ++ ICT) due to ++ size of hematoma.Herniation & DAMAGE TO VITAL centers in brainstem.Neurological sequelea (dementia, neurosis, epilepsy, sepsis,. Deterioration of concious level) -Cause of death : fatal concussion, compression, herniation, associated brain laceration, intracranial sepsis, epilepsy) -

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30 Intracerebral Hge Presenting part ( brain cerebral hemishere) -Description of the lesion. Intracerebral hge ( DESCRIBE)) -Mechanical cause.due to natural causes as hypertension or trauma (from branches of middle cerebral a.) -Complications.Concussion &post-concussion syndrome.Compression( ++ ICT).Herniation & DAMAGE TO VITAL centers in brainstem.Neurological sequelea (dementia, neurosis, epilepsy, sepsis,. Deterioration of concious level). Associated brain damage ( cerebral edema) -Cause of death : fatal concussion, compression, herniation, associated brain laceration, intracranial sepsis, epilepsy) --M.L.I: IF DISCHARGED and death occurs ( negligence against unsuspecting doctor))


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