Pattern and Morphological Spectrum of Craniocerebral Trauma and Cranio-Cervical Junction Injuries in Fatal Falls from Height: An Autopsy-Based Study

Abstract

Background: Falls from height (FFH) are a principal cause of blunt neurotrauma encountered in forensic mortuaries. Craniocerebral trauma remains the leading cause of lethality. Objectives: To evaluate the morphological spectrum, intracranial haemorrhage patterns, skull fracture distributions, and cranio-cervical junction disruptions in fatal fall-from-height autopsies. Materials and Methods: An observational autopsy study of 100 fatal FFH cases autopsied at SMS Medical College, Jaipur between September 2024 and September 2025. Data regarding scalp injuries, skull fractures, meningeal/parenchymal bleeds, brain contusions, and upper cervical spine injuries were recorded systematically. Results: Cranio-cerebral involvement was identified in 83% of victims. Direct head impact was the primary point of contact in 68% of cases. Intracranial haemorrhages occurred in 64% of cases, and cerebral contusions in 60%. Subdural haemorrhage (SDH, 48%) and subarachnoid haemorrhage (SAH, 48%) were the predominant intracranial lesions, followed by extradural haemorrhage (EDH, 13%) and intraventricular haemorrhage (IVH, 9%). Skull vault fractures were observed in 36% of cases. Associated cervical spine fractures occurred in 23% and cord trauma in 18%. Coma was the mode of death in 57% of subjects, directly attributable to lethal head injury in 58%. Conclusion: Craniocerebral trauma, especially diffuse contusional and extra-axial subdural/subarachnoid injury, is the primary fatal mechanism in falls from height. Routine post-mortem evaluation must combine dural reflection with cranio-cervical dissection to uncover occult neuroaxial injuries.

Keywords: Fall from height, Craniocerebral trauma, Skull fracture, Subdural haemorrhage, Autopsy.