Alabama, United States. This young man was working at a loading dock when a reversing semi-trailer crushed his head against a wall. In fig.1, note the obviously distorted appearance of the head, the internal aspect of which is demonstrated in fig.2. There are multiple widely displaced skull fractures at the skull base. We see evidence of extruded brain matter, this time into post-cranial areas with figs.3–4 illustrating brain matter in the stomach and bronchi, respectively. One can appreciate that very high pressure is formed within the skull with these types of injuries. This translates into the forcible displacement of cranial contents into the pharynx, trachea, and esophagus.
Fig.1 Obviously distorted appearance of the head.
Fig.2 Internal aspect of the head.
When the head is impacted by a moving object while it is resting against an immovable surface, crush injuries occur. In these circumstances, skull bones have widely displaced comminuted fractures, the brain is lacerated, pulpified and may be extruded through the cranial and scalp injuries.
Fig.3 Brain matter in the stomach.
Fig.4 Brain matter in the bronchi.
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