Trauma
The role of detailed pathological study of brain in head injury to understand the pathology and evaluate the extent of pathological damage as a cause of fatal outcome is emphasised.
Abstract
Diffuse axonal injury (DAI). a severe type of diffuse brain damage in non missile head injury, is associated with widespread disruption of the brain function and is often missed. To understand its pathology and the sequence of events. a prospective study of fatal cases (n=356) of non-missile head injury was undertaken at "S. Detailed macroscopic examination revealed marker lesions of DAI such as haemorrhage in corpus callosum andor dorsolatrd quadrant of rostral brainstem in 57 (16%) cases out of which 7 had only DAI while 50 had associated focal lesions. Basal ganglia haemaroma. gliding contusion and intravenhicular haemorrhages were frequently associated with DAI suggesting the possibihty of a common pathogenetic mechanism in these lesions and DAI. 37brains selected for microscopic examination revealed pathological changes such as vascular damage. microhaemorrhages, axonal tears and swelling, axonal retraction halls, microglial stars. myelin loss and dystrophic neurons using routine stains, silver impregnation and immunohistochemical staining for phosphorylated newfilament protein (SM-3 1): In sections stained for phosphorylated neurofilament protein, earliest changes were seen 6 hours post injury in the form of reactive axonal swelling, focal in distribution, not identified in haematoxyline and eosin preparation. These observations emphasise the role of detailed pathological study of brain in head injury to understand the pathology and evaluate the extent of pathological damage as a cause of fatal outcome.