The American journal of forensic medicine and pathology
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Am J Forensic Med Pathol · Jun 2017
Case Reports Historical ArticleSharp Force Trauma Death in a Young Individual From Medieval Gloucester.
The authors of the present work evaluate the trauma observed on the skeletal remains of an individual from medieval Gloucester and reconstruct the events that led to his death. The almost complete skeleton was recovered from the cemetery of St Owen and dates to the late medieval period. Several methods were used to determine the sex and age of the individual. ⋯ The trauma observed on the remains consisted of 3 cut marks located on the cranium, left radius, and right scapula. The cuts seem to have been inflicted by a heavy weapon, such as a sword. The trauma pattern observed is consistent with defensive action, and the fact that this skeleton was the only one in the collection that has evidence of trauma suggests that this was a case of interpersonal violence.
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Am J Forensic Med Pathol · Jun 2017
Symptomatic Acute-on-Chronic Subdural Hematoma: A Clinicopathological Study.
The pathophysiology of acute-on-chronic subdural hematoma (ACSDH) is complex and incompletely understood. Evidence to date indicates that the overall process is initiated by rotational force with movement of the brain inside the skull, which exerts tensile strain and rupture of bridging veins, leading in turn to acute hemorrhage in the subdural potential space. This is followed by the proliferation of mesenchymal elements with angiogenesis and inflammation, which in turn becomes a substrate for repeated hemorrhage and expansion of the lesion. ⋯ Our findings highlight that ACSDH is a condition precipitated by trauma that affects middle-aged and older adults, is relatively indolent, is unilateral or asymmetric, and has a low in-hospital mortality rate. Pathological analysis demonstrates a substantial outer membrane in all cases with varying degrees of inflammation and organization that cannot be precisely dated as a function of clinical presentation. The extrapolation of adult ACSDH to mixed acute and chronic subdural hemorrhage in the pediatric setting is problematic due to substantial differences in clinical presentation, severity of underlying brain injury, gross and microscopic findings, and outcome.