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A subacute epidural haematoma extending over the occipital region and posterior cranial fossa due to a laceration in the transverse sinus

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Abstract

A 6-year-old male was found dead on his stomach with massive reddish vomiting from his mouth and nose. Postmortem cranial CT revealed an epidural haematoma in the left occipital region, but the cause and origin of the haematoma were unclear. An autopsy revealed that the epidural haematoma expanded over the left temporal region and the left side of the occipital region and posterior cranial fossa, and its origin was a laceration in the left transverse sinus induced by diastases in the left lambdoidal and occipitomastoid sutures. A pathohistological examination revealed that one portion of the haematoma was an early-stage hemorrhage, while the other portion extended approximately 1 week after the hemorrhage. Moreover, approximately 1 week elapsed after the laceration of the transverse sinus. Thus, we believe that the primary haematoma was induced by the laceration in the transverse sinus approximately 1 week before death, but the haematoma ceased to enlarge due to hemostasis. However, later, the size of the haematoma rapidly increased again due to rebleeding from the laceration, which led to intracranial hypertension. Consequently, we diagnosed the direct cause of death as choking due to vomit aspiration that resulted from intracranial hypertension induced by a subacute epidural haematoma.

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Authors and Affiliations

  1. Department of Forensic Medicine and Sciences, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan

    Hiromasa Inoue, Yasuhisa Nakagawa, Mayumi Ikemura, Kotaro Shinone, Kana Okada & Masayuki Nata

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  1. Hiromasa Inoue
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  2. Yasuhisa Nakagawa
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  3. Mayumi Ikemura
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  4. Kotaro Shinone
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  5. Kana Okada
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  6. Masayuki Nata
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Correspondence to Hiromasa Inoue.

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Fig. 3. Microscopic examination of the epidural haematoma and dura mater. a–c The haemorrhage is clearly divided into three structures. The outermost layer of the EDH in the dura mater shows numerous erythrocytes with scattered macrophages, lymphocytes, and fibroblasts, and is negative for Fe staining. In the centre of the EDH, erythrocytes, some macrophages, and lymphocytes are observed within the fibrin fibres, which are negative for Fe staining (a HE ×40; b Fe staining ×40; c immunostaining using an anti-CD68 antibody ×100). d and e The third structure of the haemorrhage consists of erythrocytes, slight neutrophil infiltration, and the infiltration of lymphocytes, macrophages, and fibroblasts. This structure is positive for Fe staining, especially in the macrophages (d HE ×100; e Elastica van Gieson staining ×100). f Upon the laceration of the left transverse sinus in the dura mater, the elastic fibres on the sinus side are entirely disconnected, and the haemorrhage intrudes. However, the tissue is negative for Fe staining. The edge of the laceration is less sharp and covered with mesothelial cells, as is the surface of the hemorrhage (HE, ×100)

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Inoue, H., Nakagawa, Y., Ikemura, M. et al. A subacute epidural haematoma extending over the occipital region and posterior cranial fossa due to a laceration in the transverse sinus. Int J Legal Med 126, 467–471 (2012). https://doi.org/10.1007/s00414-011-0635-9

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  • DOI: https://doi.org/10.1007/s00414-011-0635-9

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