Intracranial Hemorrhages (ICH)
Forensic Pathology: Traumatic & Non-Traumatic Classification
1. Anatomical Classification
| Type | Vessel/Mechanism | Imaging Shape |
|---|---|---|
| Epidural (Extradural) | Middle meningeal artery; skull fracture. | Biconvex (Lens) |
| Subdural | Bridging veins; rapid acceleration/deceleration. | Crescent |
| Subarachnoid | Circle of Willis (Aneurysm rupture) or Trauma. | Sulcal pattern |
| Intracerebral | Hypertension (Charcot-Bouchard aneurysms). | Irregular/Mass |
2. Forensic High-Yield Pearls
- Subdural Hemorrhage (SDH): Acute SDH is typically venous and results from tearing of bridging veins. Chronic SDH (often in the elderly) results from repeated trauma and may form a membrane.
- The “Thunderclap” Headache: A classic clinical presentation of an aneurysmal subarachnoid hemorrhage. Forensically, always check the Circle of Willis for berry aneurysms.
- Traumatic vs. Spontaneous: In autopsy, look for coup/contrecoup patterns to support a traumatic mechanism. If no trauma is evident, prioritize the circle of Willis and hypertensive markers (cardiac hypertrophy).
- Herniation Syndromes: Death is often secondary to raised ICP, leading to Uncal (medial temporal) or Tonsillar (cerebellar) herniation.