Subdural Hemorrhage, a Retrospective Review with Emphasis on a Cohort of Alcoholics

Background characteristics and neuropathological findings of medico-legal autopsy cases with chronic alcohol use and acute head injury

Chronic alcohol use is often associated with traumatic brain injury (TBI). This study aimed to compare background characteristics, injury circumstances, primary head injuries, and secondary brain injuries among TBI cases with and without a documented history of chronic alcohol use. The sample comprised neuropathologically examined medico-legal autopsy cases with acute head injuries from Helsinki, Finland, over the years 2016-2022. Data on chronic excessive alcohol use were collected from medical records and police files; other background and circumstantial data were collected from medical records, police files, and cause-of-death investigation documents; and data on primary head injuries and secondary brain injuries were collected from autopsy and neuropathology reports. The dataset comprised 47 cases, of whom 19 had a history of chronic alcohol use (40.4%). Assault was the most common circumstance of injury among chronic alcohol users (47.4%) while falls prevailed among control cases (32.1%); unknown circumstances were common among both groups. There were no statistically significant differences in the prevalence of primary head injuries or postinjury survival between the groups. As for secondary brain injuries, hypoxic-ischaemic neuronal injury was significantly more common among chronic alcohol users in the frontal cortex (84.2% vs. 28.6%), parietal cortex (84.2% vs. 32.1%), hippocampus (63.2% vs. 25.0%), and lenticular nucleus (73.7% vs. 21.4%). Our findings suggest that chronic alcohol users may not necessarily have more diverse or complex primary injuries, but they may have more extensive secondary injuries. Further research should aim to explore the potential aetiology of hypoxic-ischaemic neuronal injury among chronic alcohol users.

Autopsy-Diagnosed Injury Deaths in Persons With Acute or Chronic Alcohol Use: A Review of 1000 Deaths With History of Alcohol Use

ABSTRACT

Acute and chronic alcohol use is associated with injury, and autopsies may be performed to ascertain injury deaths in persons with acute or chronic alcohol use. This study sought to determine how many decedents with a history of acute or chronic alcohol use had an internal physical injury diagnosed only at autopsy that caused or contributed to the death. The study reviewed medicolegal investigation and autopsy reports at the New York City Office of Chief Medical Examiner between January 1 and October 11, 2018, to identify 1000 consecutive persons with suspected acute or chronic alcohol use who were autopsied to ascertain whether internal physical injury caused or contributed to the death. Of 1000 persons with known or suspected acute or chronic alcohol use, 390 (39.0%) had an external injury. Although 115 (11.5%) had an internal injury at autopsy, only 29 (2.9%) had an injury that caused or contributed to the death. Only 1 decedent had an internal injury that caused the death with no associated external evidence of injury (0.1%). This study demonstrates the rarity of occult lethal injury diagnosed at autopsy in persons with acute or chronic alcohol use.