DOI: https://doi.org/10.53350/pjmhs22165727 ORIGINAL ARTICLE P J M H S Vol. 16, No. 05, May 2022 727 Frequency of Intracranial Hemorrhages in Medico-Legal Death Cases NASEEM AKHTER 1 , FAYAZ AHMED MEMON 2 , AMBREEN TARIQ CHATTHA 3 , ABDUL SAMAD 4 , ALIYA ABRAR 5 , AISHA RASHEED SHAIKH 6 1 Senior Lecturer, Department of Anatomy, Sindh Medical College, Jinnah Sindh Medical University, Karachi Sindh, Pakistan 2 Professor of Medicine, Department of Medicine, Muhammed Medical College & Hospital, Mirpurkhas 3 Senior Demonstrator, Deptt of Forensic Medicine & Toxicology, Abwa Medical College, Faisalabad 4 Associate Professor, Department of Forensic Medicine and Toxicology, Liaquat University of Medical & Health Sciences, Jamshoro Sindh, Pakistan. 5 Lecturer, Dept of Forensic Medicine, Sir Syed College of Medical Sciences for Girls, Karachi 6 Assistant Professor, Department of Forensic Medicine and Toxicology, Liaquat University of Medical & Health Sciences, Jamshoro Sindh, Pakistan. Corresponding author: Dr. Fayaz Ahmed Memon, Email: memonfayaz625@gmail.com, Cell: 03333987196 ABSTRACT Objective: To analyze the occurrence of cerebral bleeding in medically assisted deaths. Study Design: Cross-sectional Place of Study: Department of Forensic Medicine & Toxicolgy, Peoples University of Medical & Health Sciences for Women (PUMHSW), SBA and Peoples Medical College Hospital (PMCH) Nawabshah, Sindh, Pakistan from 1 st October 2021 to 31 st March, 2022. Materials and Methods: For this research, 94 people were enrolled. After obtaining written permission, all of the patient's demographic information was gathered. Analysis of all patients' tissue specimens. Toxicology and alcohol testing were performed on the blood sample. All cases were evaluated using X-rays and autopsy were carried out for all of them. Decomposed remains were not included in our research. Results: Among 94 cases, there were 60 (63.8%) males and 30 (36.2%) females. Included patient had mean age 31.45±13.43 years and had mean BMI 22.19±20.48. Frequency of deaths with intracranial lesion was found in 14 (14.9%) cases. We found that frequency of traumatic cases were higher than that of non-traumatic (cerebro-vascular accidents). Frequency of intracranial lesions alone was found in 31 (32.9%) cases. Hemorrhages in the subarachnoid space were the most frequent intracranial pathology. The most prevalent cause of delayed death is pneumonia. Conclusion: The number of deaths that were caused by cerebral trauma was found to be very low in this research; nevertheless, the bulk of deaths were caused by injuries to other anatomical regions. Keywords: Trauma, Intracranial lesion, Mortality INTRODUCTION TBI (traumatic brain injury) or natural reasons may result in intracranial haemorrhage. Both are possible causes. Traumatic causes include road traffic accidents, falls from height, railway mishaps, assaults, and other accidents. Natural causes include strokes, tumours, and bleeding diseases, among others. Indians die from fatal cerebral haemorrhages per year. Intracranial haemorrhages may occur regardless of the severity of the head injury. Intracranial haemorrhage was found in two-thirds of the patients who presented in coma to Bullock and Teasdale.[1] Any of these may be present at the moment of injury, but they can also develop over time or grow in size. Extra Dural Haemorrhage (EDH) is most often related with skull fractures and occurs at the point of impact in most instances. [2] That which sits between the skull and the dura mater is an ovoid mass of blood clots.[3] Only 5 to 15 percent of fatal head injuries have it, and 85 percent of those injuries had fractures as a co-morbidity. It is very rare. In a study by Rowbotham, these instances accounted for between 3% and 5% of any large series of severe brain trauma[4,5]. As a result, the prevalence of these injuries amongst head traumas in post-mortem rooms is reduced. Trauma is the most common cause of extradural haemorrhage, with the notable exception of blood dyscrasias in infancy. [6] Non-traumatic (natural) brain lesions may result from elevated intracranial pressure, cerebrovascular illness, metabolic problems, malignancies of the central nervous system (CNS), neurodegenerative diseases, infections of the CNS, and myelin diseases. [7] Intracranial haemorrhages (more than 50% of cases), seizures, neurodegenerative disorders, hypoxic-ischemic lesions with strokes, intracranial tumours, primarily CNS infections, multiple sclerosis and developmental disorders with predominance of the male gender in all age groups except for the neurodegenerative disorders (dementia disorders), which are primarily seen in older adults [8] Intracerebral haemorrhages, according to Al-Qazzaz, are a common complication of severe brain injuries. Hemorrhages and skull fractures were two of the most common causes of mortality in his research of road traffic accidents. [17] Brain damage may be produced by a direct hit or just by acceleration alone. There are a number of events that may occur in the minutes and days that follow an injury to the brain, on top of the immediate harm. A number of mechanisms, including changes in cerebral blood flow and the pressure inside the skull, contribute significantly to the damage caused by the original injury. [9] An intracranial haemorrhage known as a traumatic intracerebral haemorrhage (TICH) happens when bleeding occurs inside the brain's tissue. Penetrating head trauma is the most common cause of (TICH), however it may also be caused by depressed skull fractures, acceleration/deceleration traum, or a combination of these. [10]. TICH's harmful consequences include a mix of primary damage (the destruction of local tissue caused by the hematoma itself and the associated rise in ICP) and secondary effects induced by the toxic effects of blood on nearby tissue, which are both caused by the procedure. To these processes, we should take into account the impact of internal barotrauma-induced diffuse cerebral fluid percussion damage as well. Increased intracranial pressure (ICP), mass effect, or herniation cannot necessarily explain the changes in awareness that occur following traumatic intracranial haemorrhage (TICH). As previously mentioned, brain alterations that persist for many days following acute (TICH) damage show that there is a prolonged window of opportunity for intervention to enhance neurological prognosis. [11,12] To better understand the prevalence and forms of cerebral lesions in medical-legal death situations, we undertook the current research. MATERIAL & METHODS This interventional comparative study was carried out at Department of Forensic Medicine & Toxicolgy, Peoples University of Medical & Health Sciences for Women (PUMHSW), SBA and Peoples Medical College Hospital (PMCH) Nawabshah, Sindh, Pakistan from 1 st October 2021 to 31 st March, 2022 and comprised of 94 cases. Medical records and police reports both provided copious amounts of information on each victim, including their age, gender, cause of death, and a long list of other personal details. All patients had their blood drawn for toxicology and alcohol testing