Forensic aspects of non-traumatic intracerebral hemorrhage: a case report

Abstract

Background. Cases when unexpected death occurs, when the patient is in apparent health or the event comes during presumably normal activity, especially when it is unwitnessed or when the victim is found without apparent signs of foul play, may pose a significant challenge to the coroner in reaching a proper determination of the cause and the manner of death. Spontaneous intracerebral hemorrhage (ICH) is a bleeding into the parenchyma of the brain and accounts for approximately 10 % to 20 % of all strokes. ICH is a multi-factorial disease caused by several interacting and overlapping risk factors and etiologies. When massive ICH, not connected with head trauma, has occurred, and it is multifocal or not located in one of the typical sites for hypertensive hemorrhage, one of a multitude of other causes must be suspected. High alcohol intake increases the risk of all stroke subtypes and of the development of liver diseases and may induce hypertension, by affecting brain function and producing a series of alcohol-related or alcohol caused diseases and is associated with changes in the coagulation system. Liver cirrhosis is a well-known risk factor for ICH, due to impaired coagulation, despite the relatively rare occurrence of ICH in cirrhotic patients.