Minor Head and Neck Findings in Fatal Upper Cervical Cord Injury: Frequency and PMCT–Autopsy Correlation

<title>Abstract</title> <p>Background Postmortem CT (PMCT) is widely used in forensic investigations, but the cord injury itself is not directly visualized on non-contrast CT. Associated head and neck findings may therefore be important to recognize. However, their frequency and how reliably postmortem computed tomography (PMCT) depicts them relative to autopsy are not well characterized. This study aimed to determine the incidence of these findings, characterize their PMCT–autopsy correlation, and consider their forensic relevance. Methods This retrospective study included 26 autopsy-confirmed fatal trauma cases involving the upper cervical cord or craniocervical junction (C1–C3 or the pons-medulla region). PMCT images were reviewed for the presence of subarachnoid hemorrhage, head and neck soft tissue hemorrhage, and craniocervical skeletal injuries. The frequencies of PMCT findings were summarized, and the PMCT–autopsy correlation was assessed descriptively. Results Subarachnoid hemorrhage was observed on PMCT in 14 cases (53.8%) and head or neck soft tissue hemorrhage in 22 cases (84.6%). Either subarachnoid hemorrhage or head/neck soft tissue hemorrhage was present in all 26 cases. Major craniocervical skeletal abnormalities were identified in 24 cases (92.3%). The PMCT–autopsy correlation analysis showed that several subtle findings were underestimated or detected only at autopsy. Conclusion Major craniocervical skeletal abnormalities are visible on PMCT in most cases of fatal upper cervical cord injury, and at least one accompanying skeletal or hemorrhagic finding is observed per case. However, subtle hemorrhagic findings are frequently underestimated on PMCT relative to autopsy. Therefore, PMCT and autopsy are complementary.</p>