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Jurors in the trial of a Tucson woman accused of killing her 5-year-old son spent most of Friday listening to the gruesome details of his autopsy.

Dr. David Winston, a forensic pathologist, said he believes Brandon Williams died as a result of a 3 1/2-inch skull fracture that extended upward from the top of his spine.

The fracture could have been caused by a fall but was more than likely the result of someone striking the boy, Winston said. Someone could also have caused the boy's head to strike a blunt object, such as a tile floor, he said.

Diane Marsh, 41, is charged with first-degree murder and four counts of child abuse in the boy's death on March 22, 2007.

According to testimony, Brandon died at Northwest Medical Center less than an hour after one of Marsh's roommates called 911 to say he had stopped breathing.

Paramedics called the Pima County Sheriff's Department because they saw marks on Brandon's wrists, ankles and feet that indicated he had been tied up and burned.

Neither Winston nor detectives saw any head injuries on the boy at the hospital, but the autopsy revealed the skull fracture and bleeding within the brain.

Winston testified the skull fracture probably happened within 24 hours of the boy's death, but other injuries to his brain likely happened days or weeks earlier.

When he first saw Brandon's body, Winston said, he was immediately struck by the number of pale scars. He said he believes the dozens of scars were likely caused by hot water being splashed on the boy.

There were 21 marks on the boy's back alone, Winston said.

Winston told jurors there is no way to tell how old the burns were.

A number of contusions are consistent with the child banging his head, Winston said.

The autistic boy was known to bang his head frequently.

In police interviews, Marsh initially told detectives the infected injuries on Brandon's feet were caused by playing in the yard shoeless, but she later said she had dipped his feet into hot water twice in an effort to gain control of the boy.

Marsh also said she once used a clothesline to tie Brandon up and had been giving him an adult sleeping aid, Tylenol Simply Sleep, for months.

Winston noted the boy did have ligature marks around his ankles and wrists but could not say how many times the boy had been tied up.

The burns to the his feet were definitely not caused by being immersed in hot water, Winston said.

The pathologist also testified that Brandon had higher than therapeutic levels of diphenhydramine in his system. Diphenhydramine is the active ingredient in Simply Sleep.

He didn't list the drug as a contributing factor in Brandon's death because "I don't think (the pills) did contribute, but I'm not 100 percent completely sure they did not."

The trial will resume next week in the courtroom of Hector Campoy, Pima County Superior Court judge.