Citation

Bugelli V, Campobasso CP, Feola A, Tarozzi I, Abbruzzese A, Di Paolo M. Healthcare (Basel) 2023; 11(2): e228.

Copyright

(Copyright © 2023, MDPI: Multidisciplinary Digital Publishing Institute)

DOI

10.3390/healthcare11020228

PMID

36673596

PMCID

PMC9859477

Abstract

Subdural haemorrhage (SDH) as result of a traumatic brain injury (TBI) is a common cause of death in cases of fatal physical abuse. Since intracranial bleeding is a common finding in elderly due to age-related intracranial changes or increasing prevalence of anticoagulant medication, differential diagnosis between inflicted and non-inflicted head injury is challenging. A case of an elderly woman's death caused by TBI is reported. Autopsy showed multiple polychromatic bruises and a frontoparietal hematoma with bilateral subacute SDH. History excluded paraphysiological or pathological non-traumatic conditions that could justify SDH, while iatrogenic factors only played a contributory role. Since polychromatic bruises distributed on the face, the upper extremities and the chest were consistent with forceful grasping/gripping or repeated blows and SDH can form in absence of impact or by mild/minor blows, SDH was considered the result of repeated physical abuses. Differential diagnosis between traumatic and non-traumatic SDH is still challenging for forensic pathologists. As largely accepted in the pediatric population and occasionally described also in adults, however, violent shaking should be also considered as a possible mechanism of SDH-especially in elderly who do not have any sign of impact to the head.

Language: en

Keywords

traumatic brain injury; elder abuse; elder maltreatment; shaking; subdural haemorrhage