Breakdown and significance of neuropathology consultations in medico-legal autopsies in Southern Finland between 2016 and 2022.

Proficient consultation practices between a general forensic pathologist and a neuropathology specialist may prove valuable in medico-legal cause-of-death investigation. Detailed data on the current use of neuropathology consultations in medico-legal autopsies are scarce. The aim of this retrospective register-based study was to provide a breakdown of medico-legal autopsy cases associated with a neuropathology consultation in Southern Finland over the period 2016-2022. An electronic information system of the Forensic Medicine Unit, Finnish Institute for Health and Welfare, was queried for cases that underwent a medico-legal autopsy at the Helsinki office and had a neuropathological examination performed by a consultant neuropathologist. Numerous detailed characteristics of the cases were collected, and the overall significance of neuropathology consultation for the cases was assessed. The statistical approach was descriptive. A total of 216 medico-legal autopsies with a neuropathology consultation were performed over the study period. Most cases involved a full neuropathological examination (97.7 %) of a male decendent (68.5 %; age at death 0-96 years). Traumatic brain injury was the most frequent consultation theme (45.4 %), followed by epilepsy (18.1 %), hypoxia-ischaemia (14.8 %), and neurodegeneration (14.8 %). Two most often reported findings were hypoxic-ischaemic injury (76.4 %; often mild and terminal) and cerebral oedema (36.6 %). In the majority of cases, the consultation was likely to guide the selection of the underlying cause of death (64.8 %), and in a third of cases also the manner of death (32.4 %). In addition, most consultations provided the forensic pathologist with other information that was considered significant for the case (67.6 %). In conclusion, medico-legal cause-of-death investigations have clearly benefited from the neuropathology consultation practice in Southern Finland over the recent years. Descriptive and comparative analyses of neuropathology practices in other medico-legal institutions are warranted.