A post-mortem approach to intra-cranial haemorrhage and traumatic brain injury

Abstract

Intracranial haemorrhage and traumatic brain injury are entities commonly encountered by the Coroner's autopsy pathologist. Whilst some of these cases are straightforward, others are not, and these present challenges in the post-mortem room that require careful consideration and, at times, prompt decision making. Some of the questions a pathologist should ask themselves when considering the post-mortem are: are these external injuries suspicious, and should I be involving a forensic pathologist; is the pathology natural or unnatural; should I cut the brain fresh or fix, retain and refer the whole brain for neuropathology input? This review aims to serve as a practical guideline for approaching adult cases of intracranial haemorrhage and traumatic brain injury; pathologies that are encountered frequently but that can entrap the unwary. We consider the factors that should be considered before, during and after the autopsy, and the medicolegal factors of relevance in these cases.