Road traffic accident related deaths contributed 25 to 35% of all autopsies between 2003 and 2006 at the National Institute of Forensic Medicine (NIFM), Hospital Kuala Lumpur, Malaysia. Head injury, by far, was the most common cause of death recorded by the Institute. The objectives of the study were to determine: (a) the demographic characteristics of fatal motor vehicle accident (MVA) victims; (b) category of road users involved in such events; and (c) the causes of death, types of brain damage as well as presence of diffuse axonal injury (DAI) in the study subjects. Methodology: Thirty seven MVA victims were included.Brain samples were collected and analysed histopathologically by Haematoxylin & Eosin and Bielchowsky silver stains. Findings: Malays were the predominant group (46%). Males constituted 95% with 20-30 year-olds being the highest affected age group (46%). Motorcyclists contributed 67.6% of the cases. All the victims showed presence of head injury, ranging from cerebral oedema to extensive brain lacerations. Cranio-cerebral injuries were the sole cause of death in 37.8% of the subjects.