Post-mortem CT and MRI diagnosis of acute cerebral hemorrhage in a putrefied corpse

A 61-year-old man was found dead on the terrace in front of his house. The body showed external signs of advanced (Grade 4) putrefaction. Routine post-mortem computed tomography (PMCT) was conducted prior to the forensic autopsy showing a radiological alteration index (RAI) of 100. Due to a suspicious hyperdense brain lesion seen in PMCT, additional post-mortem magnetic resonance imaging (PMMR) of the head was performed for research purpose. Compared to PMCT, the lesion appeared considerably more detailed in PMMR with a slightly hyperintense and focal hypointense signal in T2w images and an isointense and focal hyperintense signal in T1w images. Autoptic assessment of the brain lesion was considerably complicated due to softening and partial liquefaction of the brain. Considering post-mortem imaging and autopsy results, the lesion was determined as an acute brain hemorrhage. Case findings indicate that PMMR may be superior to autopsy in terms of diagnosis and localization of cerebral hemorrhage in putrefied brains.