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Copper-Beaten Skull Appearance as a Response of Chronically Increased Intracranial Pressure

Bogdanović, Milenko MD; Radnić, Bojana MD; Savić, Slobodan MD, PhD; Popović, Vesna MD, PhD; Durmić, Tijana MD, PhD

The American Journal of Forensic Medicine and Pathology: March 2019 - Volume 40 - Issue 1 - p 58–60
doi: 10.1097/PAF.0000000000000444
Case Reports

We present a case of 19-year-old female patient, who was injured in childhood and subsequently developed hydrocephalus, chronic elevation of intracranial pressure (ICP), and a copper-beaten skull appearance. Chronic hydrocephalus leads to an increase in intraventricular pressure, causing ventricular expansion and dislocation of adjacent cerebral structures. According to literature data, it has been hypothesized that chronically elevated ICP in persons with craniosynostosis, and other developmental structural abnormalities of the skull, may induce bone remodeling. In cases with copper-beaten skull appearance, increased ICP should be considered as a cause of death (after exclusion of all other obvious causes), and for that reason, careful examination of the skull appearance is suggested. This finding could be useful in cases with advanced postmortem changes, where it might indicate some medical conditions of the deceased or could even be considered unique feature for body identification, although this rationale should be used with great caution.

From the Institute of Forensic Medicine “Milovan Milovanović,” University of Belgrade, School of Medicine, Belgrade, Serbia.

Manuscript received August 2, 2018; accepted September 19, 2018.

The Ministry of Science and Technological Development, Republic of Serbia (grant OI 175093) supported this work.

The authors report no conflict of interest.

Reprints: Milenko Bogdanović, MD, Institute of Forensic Medicine “Milovan Milovanovic”, University of Belgrade, School of Medicine, 31a Deligradska st, 11000 Belgrade, Serbia. E-mail:

© 2019 by Lippincott Williams & Wilkins.