Histopathological study for dating of Subdural haemorrhage and Subarachnoid haemorrhage in a single cohort study of head injury.

OBJECTIVE AND BACKGROUND: Head injury leading to meningeal haemorrhages, including subdural haemorrhage (SDH) and subarachnoid haemorrhage (SAH), is a major cause of morbidity and mortality in traumatic deaths. Determining the cause, mechanism, and dating of injury is crucial for forensic investigations. Histopathological examination plays a key role in accurately dating the injury from meningeal haemorrhages, which is essential for medicolegal investigation and the determination of the timeline of events. This study aims to evaluate histopathological changes in SDH and SAH in head injury cases and correlate them with post-traumatic survival time.

MATERIALS AND METHODS: This cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology, AIIMS, Bhopal. A total of 63 medicolegal autopsy cases of head injury having both SDH and SAH were examined with known time of injury, and time since death within 24 h, excluding decomposed cases and individuals with underlying pathological conditions that could influence haemorrhagic patterns. Collected samples were processed according to standard protocol and stained with hematoxylin and eosin. Histopathological findings, including haemorrhage, fibrin deposition, fibroblast proliferation, inflammatory cell infiltration, neovascularisation, and cell layer formation, were analysed and statistically evaluated using SPSS software.

OBSERVATIONS, FINDINGS, AND DISCUSSION: The shortest post-traumatic survival time recorded was within 1 h, and the longest was 40 days. In SDH cases, fibrin and neutrophils were observed within 24 h, while macrophages and inflammatory cells appeared by day 3. Neovascularisation and cell layer formation were noted from day 4 onward, becoming more pronounced with longer survival times. In SAH, haemorrhage and neutrophils were present within the first 24 h, macrophages appeared by day 2, and neovascularisation and multiple cell layers were observed from day 4, becoming more prominent with increased duration of post-traumatic survival time. Histological dating of haemorrhages correlated significantly with post-traumatic survival time. Histopathological examination serves as a critical forensic tool for accurately dating meningeal haemorrhages. By analysing both SDH and SAH in the same cases, this study provides novel evidence that strengthens the reliability of histology in distinguishing traumatic from pathological haemorrhage and in reconstructing timelines for medicolegal investigations.