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This report describes the autopsy findings in three cases of closed head injury dying of cerebral infarction, with brain swelling and herniation. In each instance the cause of the infarct was found to be subintimal dissection involving intracranial anterior circulation arteries. The autopsy findings underscore the value of histological examination of vessels that macroscopically appear thrombosed. We discuss factors that impact on the reported incidence and make brief mention of problems surrounding the true pathogenesis of this lesion.