Subdural Hematoma (SDH)

There are three layers which surround the brain. The outermost layer is referred to as the dura mater. After a severe head injury such as what JBR received, blood collects rapidly in under this layer from the broken blood vessels, resulting in a subdural hematoma. They are usually huge, especially in a head injury of this magnitude. JBR's hematoma was very small, only about 2 teaspoons of blood, which means that it consisted of only the residual blood which was in the surrounding capillaries at the time, which means that her heart was no longer beating at the time she was hit on the head.

I have not read Dr. Lee's book yet and will need to pick that up. Given the fact that his stated opinion is that she was struck on the head first, how does he explain the fact that the SDH was so very small?

Dr. Lee is not an MD. That's not his area of expertise.

He's also the one who testified in the Kathleen Peterson murder trial that there was too much blood for a beating. This is the case where the husband tried to claim it was a fall down the stairs. There was blood all over, even high up the walls, evidence of attempted clean up, and spatter inside the shorts of the husband.

Isn't Dr. Lee a scientist whose specialty is DNA, rather than perform autopsies?

If the blow to the head was first and the death occurred later due to strangulation as the result of staging, she would have still been alive, her heart would have been beating, and it would have pumped a large amount of blood in this area, resulting in the typically very large hematoma, rather than the few milliliters of blood that was found in JBR's case.

Bluecrab found this:-


http://web.dailycamera.com/extra/ramsey/2001/03lrams.html

...


Adams County Coroner Mike Dobersen said he reviewed the autopsy photographs and thinks there would have been much more internal bleeding inside the brain if JonBenét had been struck first and strangled later.

But Kerry Brega, chief neurologist at Denver Health Medical Center, said it is not uncommon for people with skull fractures to not have any bleeding. "We see a lot of people with skull fractures without bleeds in the brain, and they didn't all get strangled on the way in," she said. "So it is actually possible to get a skull fracture without getting an underlying bleed in the brain." ...

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Except for the fact that she DID have bleeding in her brain. It was just a very small amount, the same amount that would have been present in her capillaries at the time, and no further amount of blood was pumped into the area. That does not make sense to me if she were still alive at the time she received the head trauma.

Thanks, Jayelles. I was looking all over for that.

[shiloh] "Given the fact that his stated opinion is that she was struck on the head first, how does he explain the fact that the SDH was so very small?"

Well, Dr. Werner Spitz is a forensic pathologist, and he agreed with Lee: the blow came first. If someone could find out how to contact him, it might help us out.

Shiloh, head wounds are a strange thing. My dad fought in Vietnam. He saw plenty of guys with head wounds. Some died instantly, some lived for hours. You forget that the hematoma you're talking about measured some 8x4 inches. That's quite a lot of coverage, even for an adult.

SuperDave said:

You forget that the hematoma you're talking about measured some 8x4 inches. That's quite a lot of coverage, even for an adult.

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No, it was the scalp hemorrhage which measured 7 x 4 inches. The subdural hematoma consisted only 7-8 cc, which is simply the amount which would have leaked out of broken capillaries with no force of blood being pumped through them.

My bad.

Okay, how about this: the blow affected her circulatory system.

I'm not qualified to answer that. I don't know if that is possible. Perhaps that is Dr. Lee's contention.

I have heard that skull fracture without bleeding crap too many times.

And they never say ... "Hey! It's real possible to get a an 8 1/2" skull fracture with a bone displacement without much internal bleeding and without splitting the skin on the skull."

It's always "A SKULL FRACTURE". No more.

twinkiesmom said:

Dr. Lee is not an MD. That's not his area of expertise.

He's also the one who testified in the Kathleen Peterson murder trial that there was too much blood for a beating. This is the case where the husband tried to claim it was a fall down the stairs. There was blood all over, even high up the walls, evidence of attempted clean up, and spatter inside the shorts of the husband.

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Was that the ketsup demonstration? That was weird.

shiloh said:

If the blow to the head was first and the death occurred later due to strangulation as the result of staging, she would have still been alive, her heart would have been beating, and it would have pumped a large amount of blood in this area, resulting in the typically very large hematoma, rather than the few milliliters of blood that was found in JBR's case.

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That's what I would think would happen.

shiloh said:

I'm not qualified to answer that. I don't know if that is possible. Perhaps that is Dr. Lee's contention.

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If it is, I doubt he came up with it on his own. Werner Spitz seems to think that happened. (At least, he's never spoken against it.)

shiloh said:

If the blow to the head was first and the death occurred later due to strangulation as the result of staging, she would have still been alive, her heart would have been beating, and it would have pumped a large amount of blood in this area, resulting in the typically very large hematoma, rather than the few milliliters of blood that was found in JBR's case.

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I totally agree with your assessment shiloh.

The topic of the small amounts of hemorrhaging (the area of 7 x 4 sq inches of blood beneath the skull and the absence of major clotting, the thin film amounting to 7-8 mls of subdural blood and another thin film of subarachnoid blood) all indicating that the blood supply to the head was restricted, has been discussed before and I have had long arguments with rashomon, along with various others, who still insist the head blow came first.

There is also the matter of the presence of petechial hemorrhages on the conjunctival surfaces of the eyes, the skin of the upper eyelids both commonly occurring as the result of strangulation, not to mention the same hemorrhages above and below the anterior projection of the ligature furrow, none of which would have occured if the head blow came first and the neck ligature was only staging.

Jayelles said:

Bluecrab found this:-


http://web.dailycamera.com/extra/ramsey/2001/03lrams.html

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But JonBenet's blood vessels WERE broken and she DID bleed. It's just that the bleeding in her case was unnaturally short-lived, a fact that needs explaining. And the most obvious explanation is that she had a ligature tied tightly around her neck restricting the blood flow from her heart.

aussiesheila said:

But JonBenet's blood vessels WERE broken and she DID bleed. It's just that the bleeding in her case was unnaturally short-lived, a fact that needs explaining. And the most obvious explanation is that she had a ligature tied tightly around her neck restricting the blood flow from her heart.

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But suppose the head blow was so severe that it put her in a deep coma, with her heart beating very weakly - wouldn't that explain the relatively small amount of blood in her brain (that is, if it was a small amount at all - I'm no medical expert). There was also swelling of her brain, and according to info posted here, it takes some time for a brain to swell after an injury.

"There is also the matter of the presence of petechial hemorrhages on the conjunctival surfaces of the eyes, the skin of the upper eyelids both commonly occurring as the result of strangulation, not to mention the same hemorrhages above and below the anterior projection of the ligature furrow, none of which would have occured if the head blow came first and the neck ligature was only staging."

Well, some have suggested she was strangled by something else first.

But I don't think anyone disputes that she was still alive when the ligature was used, just in shock, possibly comatose when it was applied. You have to remember: as ferocious as the photos of her neck look, the autopsy report said that the larynx and hyoid bone wasn't damaged.

"But suppose the head blow was so severe that it put her in a deep coma, with her heart beating very weakly - wouldn't that explain the relatively small amount of blood in her brain (that is, if it was a small amount at all - I'm no medical expert). There was also swelling of her brain, and according to info posted here, it takes some time for a brain to swell after an injury."

if in shock, the blood pressure drops drastically. Breathing becomes shallow. Strangulation can occur with little pressure when the body cannot expand to take it air.

Think of a python constricting a victim. It doesn't really do any work. It wraps around its victim, but it is the prey's own exhalations that do it in. Every time the breath is expelled, the snake's scales interlock, so the prey cannot breath in as much. This process continues until the snake senses its victim is weak enough and puts the final, crushing squeeze on.

What I'm saying is, it might not have taken much at all.

But I could be way off. The cord MIGHT have been like the snake, with a knot that didn't allow it to loosen easily. It might not.

rashomon said:

But suppose the head blow was so severe that it put her in a deep coma, with her heart beating very weakly - wouldn't that explain the relatively small amount of blood in her brain (that is, if it was a small amount at all - I'm no medical expert).

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Hate to disagree with you rashomon, but I don't think so. I think that even if you are in a deep coma the heart still pumps eficiently and gets plenty of blood to the brain, otherwise you would slowly die.

rashomon said:

There was also swelling of her brain, and according to info posted here, it takes some time for a brain to swell after an injury.

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I don't think this is correct. Some people are saying this because the autopsy says the sulci are mildly narrowed and the gyri flattened but I'm not so sure this means swelling, although it might. But even so, mild narrowing would be only mild swelling I would have thought. A medical expert on the forum would help. The autopsy report says "no inflammation" but doesn't mention any swelling as such.

SuperDave said:

Well, some have suggested she was strangled by something else first.

But I don't think anyone disputes that she was still alive when the ligature was used, just in shock, possibly comatose when it was applied. You have to remember: as ferocious as the photos of her neck look, the autopsy report said that the larynx and hyoid bone wasn't damaged.

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So you are arguing for a strangulation with the hands first, followed by a bash over the head, then the application of a neck ligature for staging purposes only? And you are saying that the fact that the larynx and hyoid bone weren't damaged mitigates against a ligature having been used for the actual strangulation?

of blood" - there were three areas of hemorrhage - "an extensive area of scalp hemorrhage...approx 7 x 4 " - "on removal of the skullcap there is a thin film of subdural hemorrhage measuring approx 7-8 cc over the surface of the right cerebral hemisphere." - then, "there is a thin film of subarachnoid hemorrhage overlying the entire right cerebral hemisphere." - then Meyers says there is "an 8" contusion [under the fracture] in length up to 1.75" in width." So there were two areas of hemorrhage plus a contusion, plus a contusion of the right temporal lobe and minor bruising of the left temporal lobe. There were purple striations throughout the entire right hemisphere which means that it had been bleeding, but the blood settled when livor mortis set in. Purple striations are indicative too that the body had been moved, because they happen after death and as the body is shifted the blood moves to the lowest point of gravity. Now, if the skull fracture had come after the aphixiation, then there would not be any hemorrhage because the blood would have stopped pumping blood to the brain.

Also, the petechial hemorrhages in the eyes can be caused by the brain shaking back and forth in the skull cavity. She might have been in agonal death, where the killer thought she was dead, but her heart was still faintly beating. I have no doubt that the second the fracture occurred she went down and was completely out.