Absence of cerebrospinal fluid at the brain base during autopsy is related to head trauma in young and middle-aged individuals

ABSTRACT Cerebrospinal fluid (CSF) collection and examination are critical diagnostic procedures in forensic autopsies. However, CSF cannot always be collected, even in cases without severe head injury and where postmortem decomposition is not significantly advanced. This study aimed to analyze the conditions under which CSF cannot be collected from the base of the brain during autopsy and to evaluate its association with ante- and post-mortem conditions. Based on autopsy findings regarding the presence or absence of CSF in the subarachnoid space at the base of the brain, 138 cases were divided into two groups: 96 with CSF and 42 without CSF. Binomial logistic regression analysis was performed to identify factors associated with the inability to collect CSF, using age, survival period, postmortem interval, and head injury as explanatory variables. Head injury was identified as the primary factor associated with the absence of CSF at the brain base, whereas increasing age was negatively associated with its absence. Although this study is based on the analysis of a limited number of autopsy cases from a single institution, these findings suggest that the absence of CSF at the base of the skull during autopsy in young and middle-aged individuals is related to head trauma. Because the presence or absence of CSF at the base of the brain can be readily confirmed during autopsy, this observation may assist in the diagnosis of head injuries and the detection of concealed head trauma, thereby improving autopsy accuracy.