The Role of Autopsy in the Forensic and Clinical Evaluation of Head Trauma and Traumatic Brain Injury in Road Traffic Accidents: A Review of the Literature

Abstract

Road traffic accidents (RTAs) are a leading cause of morbidity and mortality worldwide, frequently resulting in traumatic brain injuries (TBIs), skull fractures, and spinal injuries. This manuscript examines the forensic aspects of head trauma caused by RTAs, focusing on the role of autopsy and imaging in diagnosing and characterizing injuries. Through a systematic review of the literature, the study highlights the mechanisms of injury, including high-speed collisions, whiplash, and pedestrian impacts, and explores their pathological consequences, such as subarachnoid hemorrhage, intracranial hemorrhage, and diffuse axonal injury. The differentiation between traumatic and non-traumatic conditions, such as aneurysmal subarachnoid hemorrhage, is emphasized to ensure accurate clinical and forensic assessments. Advances in imaging technologies, particularly virtopsy, are discussed for their potential in non-invasive documentation and analysis of head injuries, while limitations of this approach are acknowledged. Furthermore, the manuscript underscores the importance of preventive measures, including helmet and seatbelt use, vehicle safety innovations, and improved road design, in reducing the incidence and severity of RTAs. By integrating clinical, forensic, and preventive perspectives, this study provides a comprehensive framework for understanding and addressing the burden of head trauma related to RTAs.

Keywords: autopsy; head injury; road traffic accidents.

Figure 1

Analysis of head trauma in the frontal region. This image depicts significant bruising and lacerations on the frontal area of the skull. The external injuries suggest a high-energy impact consistent with head-on collisions.

Figure 2

Cerebral hemorrhage found upon opening of the skull. This figure reveals extensive subarachnoid hemorrhage (SAH) visible upon gross examination. The bleeding pattern suggests rupture of vessels in the subarachnoid space, likely due to rapid deceleration forces during the accident.

Figure 3

Trauma of the left parietotemporal region. The illustration shows localized contusions and fractures in the left parietotemporal region, correlating with lateral impacts.

Figure 4

Detailed view of the bleeding into the subarachnoid space, with clear demarcation of the hemorrhage.

Figure 5

Hemorrhagic infiltration extending into the temporalis muscle, which often indicates a high-impact injury. The presence of hemorrhage in soft tissues supports findings of significant blunt force trauma.

Figure 6

Subdural hemorrhage at skull opening, with extensive bleeding visible on the brain.

Figure 7

Complete skull base fracture and its extent. The fracture originates from the left middle cranial fossa, traverses the sella turcica, and extends to the anterior cranial fossa. This trajectory crosses critical anatomical structures, potentially compromising the brainstem and cranial nerves, highlighting the severity and life-threatening implications of such injuries.