EXSANGUINATION FROM IMPACT HEAD TRAUMA - THE EXPLANATION FOR THE EMPTY HEART SIGN

Twenty-four autopsied cases of lethal closed head trauma occurring suf ficiently rapidly for the salient pathologic features to remain unobsc ured by medical intervention, and selected to exclude the possibility of exsanguination by other means, were analyzed for the presence or ab sence of exsanguination fi om basal skull fracture. The purpose of thi s study was to test the validity of the ''Empty Heart'' sign in head i njuries, attributed by Hirsch and Zumwalt [C.S., Hirsch, R.E., Zumwalt , The ''Empty Heart'' sign, The American Journal of Forensic Medicine and Pathology 7 (2) (1986) 112-114] to a hypothetical neurologic refle x causing occult intra-corporeal sequestration of blood. The study rev ealed that the twelve cases with more seven injuries showed clear cut exsanguination (with ''empty'' hearts) due to basal skull fractures, w hile the twelve milder injury cases showed no signs of exsanguination, including the empty heart sign. No cases of cryptogenic empty heart w ere found. These findings demonstrate that the ''empty heart'' sign is merely an indication of exsanguination due to basilar skull fracture. The mechanism of exsanguination in these cases is discussed. The auth or's method for the determination of depleted blood volume at autopsy is described. The routine estimation of blood volume at autopsy and th e inclusion of investigative data in forensic case assessment are reco mmended. (C) 1998 Elsevier Science ireland Ltd. All rights reserved.