Simulation of acute subdural hematoma and diffuse axonal injury in coronal head impact

✓ The association of acute subdural hematoma (SDH) and diffuse axonal injury has received little attention in the literature. The authors report the clinicopathological findings in six patients who died of severe head injury in whom computerized tomography revealed acute SDH as the predominant lesion. All patients were injured in road traffic accidents and lost consciousness on impact. The mean total contusion index was 17.4 and severe contusions were seen in only two cases. All patients presented histological criteria of intracranial hypertension (pressure necrosis focus in one or both parahippocampal gyri). Hypoxic brain damage was evident in the postmortem examination of three patients. In three cases, macroscopic hematic lesions were observed in the corpus callosum. All patients had widespread axonal retraction balls disseminated in the white brain matter. Three patients who survived for more than 11 days had microglial clusters. In some patients with a head injury, acute SDH may be only an epiphenomenon of a primary impact lesion of variable severity: that is, a diffuse axonal injury. In these cases, the final outcome is fundamentally dependent on the severity of the subjacent diffuse axonal injury.

Download Full-text

Acute subdural hematoma and diffuse axonal injury in fatal road traffic accident victims: a clinico-pathological study of 15 patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2003000500008 ◽

2003 ◽

Vol 61 (3B) ◽

pp. 746-750 ◽

Cited By ~ 6

Author(s):

Sebastião Nataniel Silva Gusmão ◽

José Eymard Homem Pittella

Keyword(s):

Head Injury ◽

Hospital Admission ◽

Subdural Hematoma ◽

Traffic Accidents ◽

Road Traffic ◽

Axonal Injury ◽

Diffuse Axonal Injury ◽

Acute Subdural Hematoma ◽

Road Traffic Accidents ◽

Pathological Study

OBJECTIVE: Although acute subdural hematoma (ASDH) and diffuse axonal injury (DAI) are commonly associated in victims of head injury due to road traffic accidents, there are only two clinico-pathological studies of this association. We report a clinical and pathological study of 15 patients with ASDH associated with DAI. METHOD: The patients were victims of road traffic accidents and were randomly chosen. The state of consciousness on hospital admission was evaluated by the Glasgow coma scale. For the identification of axons the histological sections of the brain were stained with anti-neurofilament proteins. RESULTS: Twelve of the 15 patients were admitted to hospital in a state of coma; in three patients, the level of consciousness was not evaluated, as they died before hospital admission. CONCLUSION: The poorer prognosis in patients with ASDH who lapse into coma immediately after sustaining a head injury, as described by several authors, can be explained by the almost constant association between ASDH and DAI in victims of fatal road traffic accidents.

Download Full-text

Acute subdural hematoma and diffuse axonal injury after severe head trauma

Journal of Oral and Maxillofacial Surgery ◽

10.1016/0278-2391(89)90354-6 ◽

1989 ◽

Vol 47 (4) ◽

pp. 428

Author(s):

S.B. Knoff

Keyword(s):

Head Trauma ◽

Subdural Hematoma ◽

Axonal Injury ◽

Diffuse Axonal Injury ◽

Acute Subdural Hematoma ◽

Severe Head Trauma

Download Full-text

Clinical application of magnetic resonance in acute traumatic brain injury

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000100013 ◽

2008 ◽

Vol 66 (1) ◽

pp. 53-58 ◽

Cited By ~ 12

Author(s):

Dionei F. Morais ◽

Antonio R. Spotti ◽

Waldir A. Tognola ◽

Felipe F.P. Gaia ◽

Almir F. Andrade

Keyword(s):

Traumatic Brain Injury ◽

Subarachnoid Hemorrhage ◽

Brain Injury ◽

Magnetic Resonance ◽

Subdural Hematoma ◽

Diffuse Axonal Injury ◽

Correlation Method ◽

Acute Subdural Hematoma ◽

Acute Traumatic Brain Injury ◽

Magnetic Resonance Imaging Mri

PURPOSE: To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. METHOD: Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8%) males and 21 (38.2%) females, with acute (0 to 5 days) and closed TBI. RESULTS: Statistical significant differences (McNemar test): ocurred fractures were detected by CT in 29.1% and by MRI in 3.6% of the patients; subdural hematoma by CT in 10.9% and MRI in 36.4 %; diffuse axonal injury (DAI) by CT in 1.8% and MRI in 50.9%; cortical contusions by CT in 9.1% and MRI in 41.8%; subarachnoid hemorrhage by CT in 18.2% and MRI in 41.8%. CONCLUSION: MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI.

Download Full-text

Impact test comparisons of 20th and 21st century American football helmets

Journal of Neurosurgery ◽

10.3171/2011.9.jns111059 ◽

2012 ◽

Vol 116 (1) ◽

pp. 222-233 ◽

Cited By ~ 35

Author(s):

Adam Bartsch ◽

Edward Benzel ◽

Vincent Miele ◽

Vikas Prakash

Keyword(s):

Head Injury ◽

21St Century ◽

Injury Risk ◽

Diffuse Axonal Injury ◽

Angular Acceleration ◽

Linear Acceleration ◽

Severity Index ◽

Head Impact ◽

American Football ◽

Acute Subdural Hematoma

Object Concussion is the signature American football injury of the 21st century. Modern varsity helmets, as compared with vintage leather helmets, or “leatherheads,” are widely believed to universally improve protection by reducing head impact doses and head injury risk for the 3 million young football players in the US. The object of this study was to compare the head impact doses and injury risks with 11 widely used 21st century varsity helmets and 2 early 20th century leatherheads and to hypothesize what the results might mean for children wearing similar varsity helmets. Methods In an injury biomechanics laboratory, the authors conducted front, oblique front, lateral, oblique rear, and rear head impact tests at 5.0 m/second using helmeted headforms, inducing near- and subconcussive head impact doses on par with approximately the 95th percentile of on-field collision severity. They also calculated impact dose injury risk parameters common to laboratory and on-field traumatic neuromechanics: linear acceleration, angular acceleration, angular velocity, Gadd Severity Index, diffuse axonal injury, acute subdural hematoma, and brain contusion. Results In many instances the head impact doses and head injury risks while wearing vintage leatherheads were comparable to or better than those while wearing several widely used 21st century varsity helmets. Conclusions The authors do not advocate reverting to leather headgear, but they do strongly recommend, especially for young players, instituting helmet safety designs and testing standards, which encourage the minimization of linear and angular impact doses and injury risks in near- and subconcussive head impacts.

Download Full-text