Determination of the mechanism of formation of cranio-brain injury in consideration of the data of multispiral computed tomography: a case from expert practice

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Abstract

In everyday practice, a forensic doctor, among other things, solves the problem of accurate determination of the injury mechanism to correctly emphasize an investigation in a criminal case or based on a preliminary check, when the degree of guilt of each of the defendants in the case is established. The significance of each suspect’s “contribution” to the commission of the crime is determined by who bears the responsibility for the deed. The types of injuries in the injured person resulted from the direct impact of another person, which is simply a result of a fatal combination of circumstances at a given point in time. In such a situation, a clear answer to the question about the mechanism of injury often allows the person investigating to adequately qualify the actions of the suspect following the current Criminal Code of the Russian Federation. The situation is complicated in the examination of the victims, accused, and other persons (living persons) because unlike the examination of corpses, the forensic expert is deprived of the opportunity to examine the “native material” in detail and is limited only to the data of medical documents, and the laboratory results and instrumental research methods and examination of the subject are often presented by the investigating authorities after a long period after the incident.

The results of multislice computed tomography of the brain, as a more accurate diagnostic method than standard radiography, combined with the study of the presented case materials, made it possible to consistently determine that the complex of injuries that collectively formed a traumatic brain injury in the case of a severe traumatic brain injury, was exclusively formed as a result of a fall with a blow on a hard blunt object, thereby distinguishing between damage to the impact and counter-impact zones.

The analysis of this expert case confirms the importance of using modern methods of radiation diagnostics in forensic medicine, particularly, in determining the traumatic brain injury mechanisms.

The above case from expert practice demonstrates the importance of studying both the results of accurate methods of radiation diagnostics (multispiral computed tomography) and case materials submitted by investigative authorities to determine the mechanism of traumatic brain injury, especially in the examinations of victims, accused, and others.

About the authors

Yulia B. Li

Moscow Regional Research and Clinical Institute; Primorsky Regional Bureau of Forensic Medical Examination

Author for correspondence.
Email: reineerdeluft@gmail.com
ORCID iD: 0000-0001-7870-5746

Graduate Student correspondence

Russian Federation, Moscow; Vladivostok

Marina V. Vishniakova

Moscow Regional Research and Clinical Institute

Email: cherridra@mail.ru
ORCID iD: 0000-0003-3838-636X
SPIN-code: 1137-2991

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Vladimir А. Klevno

Moscow Regional Research and Clinical Institute

Email: vladimir.klevno@yandex.ru
ORCID iD: 0000-0001-5693-4054
SPIN-code: 2015-6548

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Multispiral computed tomography of the brain: foci of contusion of the brain (arrows), in some places confluent, in the pole parts of the temporal lobe on the left in the axial section.

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3. Fig. 2. Multispiral computed tomography of the brain: foci of brain contusion in the pole-basal regions of the temporal lobe on the left (arrows) in the sagittal section.

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4. Fig. 3. Multispiral computed tomography of the brain: fracture of the pyramid of the right temporal bone with a transition to the posterior wall of the external auditory canal and hemorrhage into the cells of the mastoid process on the right, antrum, the tympanic cavity on the right (arrows) in the axial section.

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5. Fig. 4. Multispiral computed tomography of the brain: fracture of the pyramid of the right temporal bone with a transition to the posterior wall of the external auditory canal and hemorrhage into the cells of the mastoid process on the right, antrum, the tympanic cavity (arrows) on the right in the sagittal section.

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6. Fig. 5. Multispiral computed tomography of the brain: fracture of the mastoid process of the right temporal bone with transition to the posterior wall of the external auditory meatus (arrow) on the 3D-model.

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