Therefore, the presence of a large subgaleal hematoma at the occipital level and the absence of lesions on the face speak of a lump or a fall, and not trauma caused, for example, by a blow. The presence of bruises in areas such as the neck or other indicators of struggle or defense can be useful in detecting the criminal origin of a fall, as they are rare in falls (see the blog on bruising and superficial injuries). Injuries to the game (fractures or concussions) can help reconstruct the causal mechanism. The image shows a typical lesion of falls with occipital effect: subgaleal hematoma and occipital fracture, subdural hematoma and counter-impact injuries The coincidence of the two injuries and a corresponding high bruising index means the presence of violent forces exerted on the skull (fall from height, blow and loss of consciousness with blow of the head against the ground, etc.). In the event of a fall, the impact usually occurs at the rear, front or sides of the head. Injuries to long bones or thoracoabdominal intestines are rare. Whatever the forensic etiology of a case, the reconstruction of how violations occurred in forensic pathology is always of great relevance. Sometimes they are accidents at work, with consequences that involve all kinds, even preventive. As a result of violent sex, head injuries occur, which can cause a fall. This, in turn, can lead to more head injuries.

About 70% of head injuries sustained during an attack are caused by punches or kicks, which in 12.5% of cases involves the intervention of some type of weapon or object. As we have seen, head injuries are much more common in assaults than in accidental falls. Intracranial injuries are observed in 97% of homicides. Other useful results include, for example, frictional injuries on the victim`s palms, which may indicate restraint maneuvers, either the attacker or objects, to avoid falling. The latter especially during deadly rains ([13]). In order to distinguish accidental falls from fatal falls, various criteria were used, mainly related to the number and type of injuries, their location and extent ([11]). Some authors combine the presence of these characteristics to achieve better discrimination. When a person is hit by a blow, they usually try to protect themselves in the fall when they are still conscious. This involves stretching the arms to get support with the hands.

Thus, injuries settle in these or in the wrists and even produce fractures. If, on the other hand, the subject is unconscious and falls, it is usually the head that hits the ground, which is the case with brain damage. Without wanting to find a solution to the problem, we can give a set of guidelines for expert reports on this type of injury. Many medically legal autopsies in Spain do not involve histopathology, histochemistry or electron microscopy, so INN may go unnoticed (see blog post on diffuse brain injury). This mechanism often creates an injury pattern with the following injuries: Perhaps a good example would be that of a subject pushing another and, if he falls to the ground, suffers very serious injuries or even dies. On the other hand, those who are in a relaxed state on impact often land horizontally and may suffer fewer injuries (but more often to the head). [7] In “prepared” individuals, like many accidents, especially if the subject has not lost consciousness, the injuries sustained affect many different parts of the body, due to impacts when falling against structural elements of stairs or other objects, as well as attempts to “brake” the fall. Scalp lesions should therefore be analyzed in detail. 20% of head injuries in patients visiting emergency departments and accidents in the UK are the result of bodily injury ([17]), which often involves blunt trauma in the form of punches and/or kicks to the head or face. The rule also does not apply to the assessment of injuries caused by blows, falls from heights (including stairs) or traffic accidents ([5]). If we stick to the problem of brain damage, we could try to deduce the degree of violence exerted by knowing the degree of attractiveness of cranial structures and the brain.

These results may represent a fairly characteristic pattern of injuries observed after falls or impacts with a skull struck against the ground. Another question would be whether, instead of a blow, the victim received a blow of such violence that he not only injured the face, but also hit the subject on the ground, causing him to suffer cranioencephalic injuries. In the case of falls less than 3 metres in height, the so-called reverse fall pattern ([18]), i.e. a fall with impact on the head, has been shown to be very common and results in head and cervical injuries ([19],[20]). This means that an appropriate approach to reconstructing the event is multidisciplinary and, at the medical level, not only the injuries but also other indicative elements of the witnesses, the study of the crime scene and also the medical history of the patient (history of suicide, serious illness, alcohol abuse, drugs, etc.). ([43]).