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Forensic medical analysis of closed head acceleration–deceleration injuries: a narrative review 闭合性头部加速-减速伤的法医分析：叙述回顾

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 10.1016/j.legalmed.2026.102778

Natasha Davceva , Jože Balažic

A key classification of closed head injuries, particularly relevant for reconstructing trauma biomechanics and of greatest medicolegal importance, is the distinction between contact injuries and acceleration–deceleration injuries. The two most characteristic acceleration–deceleration injuries are acute subdural hematoma (ASDH) and diffuse axonal injury (DAI), which both arise from acceleration forces applied to the head but differ in the duration of these forces.

ASDH typically results from rapid deceleration against a firm surface, as occurs in falls, falls accompanied by blows, or traffic accidents in which the head strikes the ground directly, with cyclists and motorcyclists being particularly vulnerable. In contrast, DAI is associated with prolonged acceleration–deceleration forces, usually of lower magnitude, and occurs most frequently in vehicular traffic accidents, where deformable or padded surfaces extend the deceleration phase. DAI may also result from falls from considerable heights. This review discusses the development of knowledge regarding DAI, its definition, diagnostic criteria, and key considerations, based on a literature review. Post-mortem detection requires a comprehensive forensic-neuropathological examination of fixed brain tissue, with immunohistochemistry using antibodies against β-amyloid precursor protein (β-APP) remaining the method of choice to visualize damaged axons and distinguish traumatic from ischemic patterns of injury.

In conclusion, although ASDH and DAI are both acceleration injuries and may occasionally co-occur, current evidence suggests that their coexistence more likely reflects complex injury mechanisms rather than a single, shared pathway.

闭合性头部损伤的一个关键分类，特别是与重建创伤生物力学和最大的医学重要性有关，是接触损伤和加速-减速损伤之间的区别。两种最典型的加减速损伤是急性硬膜下血肿（ASDH）和弥漫性轴索损伤（DAI），它们都是由施加在头部的加速度力引起的，但这些力的持续时间不同。ASDH通常是由于在坚硬的表面上快速减速造成的，比如在跌倒、摔倒时摔伤或头部直接撞击地面的交通事故中，骑自行车和骑摩托车的人特别容易受到伤害。相反，DAI与长时间的加减速力有关，通常强度较低，并且最常发生在车辆交通事故中，其中变形或填充的表面延长了减速阶段。从相当高的地方跌落也可能导致DAI。本文在文献综述的基础上，讨论了DAI知识的发展、定义、诊断标准和关键注意事项。死后检测需要对固定脑组织进行全面的法医神经病理学检查，使用抗β-淀粉样前体蛋白（β-APP）抗体的免疫组织化学方法仍然是可视化受损轴突和区分创伤性和缺血性损伤模式的首选方法。总之，尽管ASDH和DAI都是加速损伤，偶尔也可能同时发生，但目前的证据表明，它们的共存更可能反映了复杂的损伤机制，而不是单一的、共享的途径。

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引用次数: 0

Myocardial calcification revealed by postmortem computed tomography in a case of infantile myocardial ischemia caused by anomalous origin of the left coronary artery from the pulmonary artery 左冠状动脉起源于肺动脉的异常引起的婴儿心肌缺血的死后计算机断层显示心肌钙化。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2025-11-10 DOI: 10.1016/j.legalmed.2025.102743

Haruki Fukuda , Akira Hayakawa , Yoichiro Takahashi , Hiroyuki Tokue , Rie Sano

Bland-Garland-White syndrome, or an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), is a rare congenital coronary anomaly that can cause myocardial ischemia, congestive heart failure, and sudden death. In this study, we aimed to present a case of sudden infant death caused by ALCAPA. Postmortem computed tomography (PMCT) showed a collapsed left lung, enlarged heart volume, and severe calcification of the left ventricular papillary muscles and posterior left ventricular wall. Macroscopic examination during the autopsy revealed marked cardiac hypertrophy and an anomalous left coronary artery originating from the pulmonary artery. Furthermore, microscopic examination showed significant myocardial fibrosis with severe left ventricular calcification. Histological findings revealed features of acute-on-chronic myocardial ischemia, including myocytolysis around fibrotic and calcified areas, contraction-band necrosis, and a characteristic wavy cardiomyocyte pattern. In this case, we suggest that localized myocardial calcification detected by PMCT, particularly following three-dimensional visualization, may be useful for the postmortem assessment of ALCAPA and other causes of chronic myocardial ischemia in infants.

Bland-Garland-White综合征，或称左冠状动脉起源于肺动脉的异常（ALCAPA），是一种罕见的先天性冠状动脉异常，可导致心肌缺血、充血性心力衰竭和猝死。在本研究中，我们的目的是报告一例由ALCAPA引起的婴儿猝死。死后计算机断层扫描（PMCT）显示左肺萎陷，心脏体积增大，左心室乳头肌和左心室后壁严重钙化。尸检时的肉眼检查显示明显的心脏肥大和起源于肺动脉的左冠状动脉异常。镜下检查显示明显的心肌纤维化和严重的左心室钙化。组织学结果显示急性慢性心肌缺血的特征，包括纤维化区和钙化区周围的肌细胞溶解，收缩带坏死和特征性的波浪形心肌细胞模式。在这种情况下，我们建议PMCT检测局部心肌钙化，特别是在三维可视化之后，可能对死后评估ALCAPA和其他导致婴儿慢性心肌缺血的原因有用。

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引用次数: 0

Establishing models for postmortem interval estimation based on measuring surface temperature of corpses and ambient temperature by infrared thermography technology 利用红外热成像技术，在测量尸体表面温度和环境温度的基础上，建立了尸检间隔估计模型

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2025-11-10 DOI: 10.1016/j.legalmed.2025.102745

Chunyan Tu , Hao Zhou , Runting Dou , Yongjing Li , Tan Li , Tingting Yu , Nuo Cheng , Jingjing Niu , Yaling Xie , Heng Zhang

Body temperature is an important indicator for forensic scientists to estimate the early post-mortem interval (PMI). Traditionally, forensic practitioners have mostly used methods such as measuring the internal temperatures of the body, including rectal temperature and liver temperature, to infer the PMI. However, these methods rely on the experience of the operator, suffer from manual measurement errors, and cannot fully consider the interference of environmental factors, resulting in unstable accuracy of the inference results. Infrared thermography technology can use optoelectronic technology to dynamically and monitor the surface temperature of objects and ambient temperature. It has the advantages of non-contact, convenience, and high efficiency. This project utilized thermography technology to monitor the surface temperature of SD rat corpses and the real-time ambient temperature under five average environment temperature conditions of 25 °C, 20 °C, 15 °C, 10 °C, and 5 °C, aiming to explore the correlations among the changes in body surface temperature, ambient temperature changes, and PMI. By comparing the changes in body surface temperature of rabbits, SD rats, and C57 mice, the project investigated the relationship between body weight and the rate of body surface temperature decrease. Then, multivariate correlation analysis, multiple regression analysis, and machine learning analysis methods were employed to construct and evolve models for PMI estimation. Finally, the accuracy of the model was verified using the single-blind method. The results showed that using infrared thermography to detect body surface temperature and ambient temperature can more conveniently and accurately infer the PMI, demonstrating high application and transformation value.

体温是法医判断早期死后时间间隔的重要指标。传统上，法医从业者大多使用测量身体内部温度（包括直肠温度和肝脏温度）等方法来推断PMI。然而，这些方法依赖于操作者的经验，存在人工测量误差，不能充分考虑环境因素的干扰，导致推理结果的准确性不稳定。红外热成像技术可以利用光电技术对物体表面温度和环境温度进行动态监测。它具有非接触、方便、高效等优点。本项目利用热成像技术，在25℃、20℃、15℃、10℃、5℃五种平均环境温度条件下，监测SD大鼠尸体体表温度与实时环境温度，探讨体表温度变化、环境温度变化与PMI之间的相关性。本项目通过比较家兔、SD大鼠和C57小鼠体表温度的变化，探讨体重与体表温度下降速率的关系。然后，采用多元相关分析、多元回归分析和机器学习分析等方法构建并演化PMI估计模型。最后，采用单盲法对模型的精度进行了验证。结果表明，利用红外热像仪检测体表温度和环境温度可以更方便、更准确地推断PMI，具有较高的应用和转化价值。

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引用次数: 0

Mechanism of methamphetamine movement from the blood into the stomach 甲基苯丙胺从血液进入胃的机制

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2025-10-05 DOI: 10.1016/j.legalmed.2025.102700

Kei Yoshitome , Fumio Moriya , Masanobu Miura

引用次数: 0

Mixed planned and unplanned complex suicide by cut-throat and poisoning in a hemiplegic person − case report 有计划和无计划的混合复杂自杀由割伤和中毒在一个偏瘫的人的案件报告。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2025-12-24 DOI: 10.1016/j.legalmed.2025.102771

Hasan A. Abder-Rahman , Imad M. Al-Abdallat , Lamia K. Alsenaidi , Hasan K. Alhawwari , Safaa Z. Mahfoz , Nadia N. Jendli , Nada M. Al-Masad , Abed-Alraheem Ali

Cutthroat cases are considered rare, especially suicidal cutthroat which is scarce. This case study presents a mix between planned and unplanned complex suicidal cutthroat that complicated the decision of the manner of death. A 60 year old male with a left sided hemiplegia was found dead with deep cutthroat and had incised wounds on both wrists with a bucket filled with blood next to him, the toxicology test revealed the presence of permethrin insecticide in the stomach. This paper shows the difficulty in deciding whether the case is a planned or unplanned complex suicide and some cases might mix between the two. However, both planned and unplanned complex suicide may point to homicidal act, which is why it is recommended to record these cases especially since complex suicide is rare and there are different methods used that are unfamiliar to us. The bizarre factors that raise suspicion in our case are the hemiplegia, the age, the use of pesticides, the cut of both wrists, and the fatal cut-throat. We didn’t find any reported cases of complex suicide by poisoning with pesticides or successful cutthroat.

割喉的病例被认为是罕见的，尤其是自杀式的割喉更是罕见。这个案例研究提出了一个混合计划和非计划的复杂自杀杀手，复杂的死亡方式的决定。一名60岁男性左偏瘫患者被发现死于深喉，双手腕有切口伤口，旁边有一桶血，毒理学测试显示胃中有氯菊酯杀虫剂。这篇论文展示了在判定一个案件是有计划的还是没有计划的复杂自杀时的困难，并且一些案件可能混合了这两种情况。然而，有计划的和计划外的复杂自杀都可能指向杀人行为，这就是为什么建议记录这些案件的原因，特别是因为复杂自杀是罕见的，而且使用的方法不同，我们不熟悉。在我们的案件中引起怀疑的奇怪因素是偏瘫，年龄，农药的使用，两个手腕的割伤，以及致命的割断喉咙。我们没有发现任何报告的复杂的农药中毒自杀案例或成功的杀手。

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引用次数: 0

Sudden death due to undiagnosed cardiac metastasis of malignant melanoma revealed by autopsy: a case report 猝死原因不明心脏转移的恶性黑色素瘤尸检显示：1例报告。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2025-11-17 DOI: 10.1016/j.legalmed.2025.102756

Dorra Oualha , Taher Sakly , Oumeima Bouzid , Mariem Bel Hadj , Mejda Zakhama , Ahlem Bellalah , Nidhal Haj Salem

Cardiac metastases from malignant melanoma are rare and often remain undiagnosed until autopsy due to their nonspecific clinical presentation. The case report concerns a woman in her 40 s, with medical history of coeliac disease who presented with a triad of cholestatic jaundice, weight loss and generalised weakness. Acute cardiac symptoms occurred during the patient’s hospitalisation, with dyspnoea and palpitations preceding refractory ventricular arrhythmias and sudden death. Post mortem examination showed extensive metastatic melanoma that included the lungs, liver, spleen, lymph nodes and notably the myocardium and the endocardium. Importantly, no cutaneous or mucosal primary site was identified, classifying this case as melanoma of unknown primary (MUP). The histological and immunohistochemical analysis confirmed the diagnosis. This case report summarises the range of diagnostic issues associated with cardiac metastasis from melanoma, where the clinical presentation can mimic other cardiac pathologies and cause undiagnosed fatal arrhythmias. The findings emphasise the significance of meticulous autopsy and histological examination in elucidating unrecognized cardiac involvement in patients with metastatic melanoma, particularly in MUP.

恶性黑色素瘤的心脏转移是罕见的，由于其非特异性的临床表现，通常在尸检前无法诊断。本病例报告涉及一名40多岁的妇女，有乳糜泻病史，表现为胆汁淤积性黄疸、体重减轻和全身虚弱。患者住院期间出现急性心脏症状，在难治性室性心律失常和猝死之前出现呼吸困难和心悸。尸检显示广泛的转移性黑色素瘤，包括肺、肝、脾、淋巴结，尤其是心肌和心内膜。重要的是，没有发现皮肤或粘膜原发部位，将该病例归类为未知原发黑色素瘤（MUP）。组织学和免疫组织化学分析证实了诊断。本病例报告总结了与黑色素瘤心脏转移相关的诊断问题的范围，其临床表现可以模仿其他心脏病理并导致未确诊的致命性心律失常。研究结果强调了细致的尸检和组织学检查在阐明转移性黑色素瘤（尤其是MUP）患者未被识别的心脏病变中的重要性。

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引用次数: 0

Formalin pigment artifact in postmortem histology: Challenges and potential implications for accurate forensic differential diagnosis 死后组织学中的福尔马林色素伪影：对准确法医鉴别诊断的挑战和潜在影响。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2025-11-11 DOI: 10.1016/j.legalmed.2025.102746

Stefano Tambuzzi , Guendalina Gentile , Lorena Ferraroli, Salvatore Andreola, Riccardo Zoja

Formalin pigment is the most important artifact found in postmortem histological analyses. Although it has no forensic value, formalin pigment, when abundant or not well-known to the pathologist, can morphologically resemble, mimic or misinterpret physiological or exogenous pigments of forensic interest, making their identification challenging and leading to diagnostic difficulties. To investigate these aspects, a retrospective study was conducted on 35 autopsied bodies in various states of preservation in which postmortem histological analyses had revealed the presence of brown/blackish precipitates requiring a differential diagnosis with formalin pigment artifacts. In 29 cases (83%) it could be proven that the precipitates were not due to formalin artifacts. In some cases, however, they were of minor forensic significance, so that others could be categorised as highly forensically significant. These were mainly haemosiderin, lead from gunshot residue (GSR), granular precipitates as a result of acute poisoning with various substances and malaria pigment.

It should therefore be noted that precipitates that can be superficially assigned to formalin artifacts can conceal a multitude of pigments of different types, aetiologies and thus forensic significance, which also depend on the circumstantial and investigative context of the individual cases. For this very reason, it is of central importance for forensic pathologists to constantly question whether it may be useful to further investigate the diagnosis of suspected artifactual formalin pigment precipitates in autopsy specimens.

福尔马林色素是在死后组织学分析中发现的最重要的人工制品。虽然福尔马林色素没有法医价值，但当病理学家不知道它含量丰富时，它可以在形态上类似、模仿或误解法医感兴趣的生理或外源性色素，使其鉴定具有挑战性并导致诊断困难。为了研究这些方面，对35具尸体进行了回顾性研究，这些尸体在不同的保存状态下进行了尸检组织学分析，发现存在棕色/黑色沉淀，需要与福尔马林色素假物进行鉴别诊断。在29例（83%）中，可以证明沉淀不是由福尔马林人为物引起的。但是，在某些情况下，它们在法医上的意义不大，因此其他情况可以归类为具有高度法医意义。这些主要是血黄素、枪弹残留物（GSR）中的铅、各种物质急性中毒造成的颗粒沉淀物和疟疾色素。因此，应该指出的是，表面上被认为是福尔马林文物的沉淀物可能隐藏了多种不同类型的色素、病因和法医意义，这也取决于个别案件的环境和调查背景。出于这个原因，法医病理学家不断质疑是否有必要进一步调查尸检标本中可疑的人工福尔马林色素沉淀的诊断。

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引用次数: 0

Mucoid extracellular matrix accumulation as a histopathological marker of aortic fragility: Two autopsy cases and a literature review 黏液细胞外基质堆积作为主动脉易碎性的组织病理学标志：两个尸检病例和文献综述。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2026-01-10 DOI: 10.1016/j.legalmed.2026.102779

Marida Imbriani , Damiano Marchesini , Gianluca N. Piras , Monica La Greca , Anna Claudia Caruso , Anna Maria Manta , Benedetta Baldari

Medial degeneration of the aortic wall represents a critical substrate for the development of acute aortic syndromes, particularly dissection, in both clinically healthy individuals and those with known cardiovascular disease or syndromic features. Among these alterations, Mucoid Extracellular Matrix Accumulation (MEMA) has emerged as a key histopathological marker of aortic fragility, with implications not only for clinical practice but also for forensic investigations of sudden and unexpected deaths. This study presents two autopsy case reports of 41-year-old and 44-year-old individuals who died from acute aortic dissection with no prior evidence of cardiovascular disease or other macroscopic findings that could explain the death. Detailed histopathological examination revealed mucoid extracellular matrix accumulation and associated medial changes; in one case, acute cocaine intoxication was identified as a plausible hemodynamic trigger acting upon an intrinsically vulnerable aortic wall. Furthermore, a narrative review on MEMA and its role in medial layer alteration was conducted, allowing comparison of our findings with existing literature.

These cases highlight the forensic significance of identifying medial degenerative lesions in sudden aortic deaths. Comprehensive autopsy and histopathological assessment (hematoxylin-eosin staining) allow the recognition of MEMA and other medial alterations even in individuals without history of cardiovascular disease, support differentiation between intrinsic structural vulnerability and potential external precipitants, and contribute to a more accurate reconstruction of the mechanisms underlying unexpected aortic fatalities. Systematic evaluation of the aortic wall also improves differentiation between intrinsic aortic pathology and external triggers, contributing to scientific understanding and to forensic accuracy, and may support medico-legal evaluations of potential medical malpractice in appropriate contexts.

在临床健康个体和已知心血管疾病或综合征特征的个体中，主动脉壁内侧退变是急性主动脉综合征（特别是夹层）发展的关键基础。在这些改变中，黏液细胞外基质积累（Mucoid Extracellular Matrix Accumulation， MEMA）已成为主动脉易损的关键组织病理学标志物，不仅对临床实践有重要意义，而且对突发和意外死亡的法医调查也有重要意义。本研究报告了两例41岁和44岁的人死于急性主动脉夹层的尸检病例，没有心血管疾病的证据或其他宏观发现可以解释死亡。详细的组织病理学检查显示黏液细胞外基质积累和相关的内侧改变；在一个病例中，急性可卡因中毒被确定为一种可能的血流动力学触发因素，作用于本质上脆弱的主动脉壁。此外，我们对MEMA及其在中间层改变中的作用进行了叙述性回顾，并将我们的发现与现有文献进行了比较。这些病例强调了鉴定主动脉猝死中内侧退行性病变的法医学意义。全面的尸检和组织病理学评估（苏木精-伊红染色）允许识别MEMA和其他内侧改变，甚至在没有心血管疾病史的个体中，支持区分内在结构脆弱性和潜在的外部沉淀因素，并有助于更准确地重建意外主动脉死亡的机制。对主动脉壁的系统评估也有助于区分主动脉内部病理和外部诱因，有助于科学理解和法医准确性，并可能支持在适当情况下对潜在医疗事故的医学-法律评估。

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引用次数: 0

Application of anatomical and histological features of testis to age estimation 睾丸解剖组织学特征在年龄估计中的应用

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2025-12-24 DOI: 10.1016/j.legalmed.2025.102767

Takato Murai , Masaki Inoue , Kenichi Mukaisho , Mami Nakamura , Kazuki Takaoka , Masahito Hitosugi

In forensic practice, when parts of an unidentified human body are found, age estimation with limited materials is required. This study investigated age-related anatomical and histological changes in testes to evaluate their applicability for forensic age estimation. Testicular samples from 228 male autopsy cases (aged 0–96 years) were analyzed. The Johnsen score, testicular weight, basement membrane thickness, number of seminiferous tubules per field, and percentage of hyalinized tubules were examined. Basement membrane thickness showed a strong positive correlation with age across all subjects (r = 0.733). In individuals under 20 years, testicular weight was positively correlated with age (r = 0.89), while the number of seminiferous tubules negatively correlated (r = − 0.90). In those aged ≥ 20 years, Johnsen score, testicular weight, and hyalinization rate showed significant age-related differences between groups. Receiver operating characteristic curve analysis identified cutoff values for age discrimination: hyalinization rate of ≥ 9.0 % for ≥ 60 years (sensitivity 69.7 %, specificity 89.5 %), and testicular weight of ≤ 10.1 g for ≥ 80 years (sensitivity 85.7 %, specificity 73.3 %). Basement membrane thickness, testicular weight, and seminiferous tubule count are useful indicators for forensic age estimation under 20 years of age; on the other hand, basement membrane thickness, testicular weight, and hyalinization rate are more informative in individuals aged ≥ 20 years. These findings suggest the potential contribution of these indicators to forensic age estimation, while further studies are needed to validate their practical applicability.

在法医实践中，当发现身份不明的人体部分时，需要用有限的材料估计年龄。本研究调查了与年龄相关的睾丸解剖和组织学变化，以评估其在法医年龄估计中的适用性。本文分析了228例男性尸检病例（年龄0 ~ 96岁）的睾丸样本。检查约翰森评分、睾丸重量、基底膜厚度、每野精小管数量和玻璃化小管百分比。基底膜厚度与年龄呈显著正相关（r = 0.733）。在20岁以下的个体中，睾丸重量与年龄呈正相关（r = 0.89），精管数量与年龄呈负相关（r = - 0.90）。在年龄≥20岁的患者中，Johnsen评分、睾丸重量和透明化率在组间存在显著的年龄相关差异。受试者工作特征曲线分析确定了年龄歧视的临界值：≥60岁时透明化率≥9.0%（敏感性69.7%，特异性89.5%），≥80岁时睾丸重量≤10.1 g（敏感性85.7%，特异性73.3%）。基底膜厚度、睾丸重量和精管计数是20岁以下法医年龄估计的有用指标；另一方面，基底膜厚度、睾丸重量和透明化率在年龄≥20岁的个体中更有价值。这些发现表明这些指标对法医年龄估计的潜在贡献，但需要进一步研究来验证其实际适用性。

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引用次数: 0

Additional practical considerations in the interpretation of multiple sharp-force injuries 解释多处锐器伤的额外实际考虑。

IF 1.4 4区医学 Q3 MEDICINE, LEGAL

Legal Medicine

Pub Date : 2026-02-01 Epub Date: 2026-01-03 DOI: 10.1016/j.legalmed.2026.102773

Petr Handlos

引用次数: 0