Acute subdural hematoma and diffuse axonal injury after severe head trauma

✓ 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 brain edema in fatal head injury: analysis by dynamic CT scanning

Journal of Neurosurgery ◽

10.3171/jns.1985.63.6.0830 ◽

1985 ◽

Vol 63 (6) ◽

pp. 830-839 ◽

Cited By ~ 57

Author(s):

Eiji Yoshino ◽

Tarumi Yamaki ◽

Toshihiro Higuchi ◽

Yoshiharu Horikawa ◽

Kimiyoshi Hirakawa

Keyword(s):

Head Injury ◽

Brain Edema ◽

Subdural Hematoma ◽

Ct Scans ◽

Acute Subdural Hematoma ◽

Dynamic Ct ◽

Content Type ◽

Injured Patients ◽

Fine Print ◽

Diffuse Brain

✓ Dynamic computerized tomography (CT) was performed on 42 patients with acute head injury to evaluate the hemodynamics and to elucidate the nature of fatal diffuse brain bulk enlargement. Patients were divided into two groups according to the outcome: Group A included 17 nonfatally injured patients, eight with acute epidural hematomas and nine with acute subdural hematomas; Group B included 25 fatally injured patients, 16 with acute subdural hematomas and nine with bilateral brain bulk enlargement. Remarkable brain bulk enlargement could be seen in all fatally injured patients with acute subdural hematoma. In 29 (69%) of 42 patients, dynamic CT was performed within 2 hours after the impact. In the nonfatally injured patients with brain bulk enlargement, dynamic CT scans suggested a hyperemic state. On the other hand, in 17 (68%) of the 25 fatally injured patients, dynamic CT scans revealed a severely ischemic state. In the fatally injured patients with acute subdural hematoma, CT Hounsfield numbers in the enlarged hemisphere (hematoma side) were significantly lower than those of the opposite side (p < 0.001). Severe diffuse brain damage confirmed by follow-up CT scans and uncontrollable high intracranial pressure were noted in the fatally injured patients. Brain bulk enlargement following head injury originates from acute brain edema and an increase of cerebral blood volume. In cases of fatal head injury, acute brain edema is the more common cause of brain bulk enlargement and occurs more rapidly than is usually thought.

Download Full-text

Extradural haematoma and diffuse axonal injury in victims of fatal road traffic accidents

British Journal of Neurosurgery ◽

10.1080/02688699845249 ◽

1998 ◽

Vol 12 (2) ◽

pp. 123-126 ◽

Cited By ~ 3

Author(s):

S. N. S. GUSMAO ◽

J. E. H. PITTELLA

Keyword(s):

Traffic Accidents ◽

Road Traffic ◽

Axonal Injury ◽

Diffuse Axonal Injury ◽

Extradural Haematoma ◽

Road Traffic Accidents

Download Full-text

Outcome of diffuse axonal injury in moderate and severe traumatic brain injury

Surgical Neurology International ◽

10.25259/sni_573_2020 ◽

2021 ◽

Vol 12 ◽

pp. 384

Author(s):

Farrukh Javeed ◽

Lal Rehman ◽

Ali Afzal ◽

Asad Abbas

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Road Traffic ◽

Axonal Injury ◽

Tertiary Care ◽

Diffuse Axonal Injury ◽

Average Hospital ◽

Satisfactory Outcome ◽

Moderate Traumatic Brain Injury

Background: Diffuse axonal injury (DAI) is a common presentation in neurotrauma. Prognosis is variable but can be dependent on the initial presentation of the patient. In our study, we evaluated the outcome of diffuse axonal injury. Methods: This study was conducted at a tertiary care center from September 2018 to December 2019 and included 133 adult patients with moderate or severe head injury (GCS ≤ 12) diagnosed to have the DAI on the basis of MRI. At 3 months, the result was assessed using the Extended Glasgow Outcome Scale (GOS-E). Results: There were a total of 97 (72.9%) males and 36 (27.1%) females with an average age of 32.4 ± 10 years with a mean GCS of 9 at admission. The most common mode of head trauma was road traffic accidents (RTAs) in 51.9% of patients followed by fall from height in 27.1%. Most patients were admitted with moderate traumatic brain injury (64.7%) and suffered Grade I diffuse axonal injury (41.4%). The average hospital stay was 9 days but majority of patients stayed in hospital for ≤ 11 days. At 3 months, mortality rate was 25.6% and satisfactory outcome observed in 48.1% of patients. The highest mortality was observed in the Grade III DAI. Conclusion: We conclude that the severity of the traumatic head injury and the grade of the DAI impact the outcome. Survivors require long-term hospitalization and rehabilitation to improve their chances of recovery.

Download Full-text

Brain Damage in Fatal Non-Missile Head Injury in Relation to Age and Type of Injury

Scottish Medical Journal ◽

10.1177/003693308903400106 ◽

1989 ◽

Vol 34 (1) ◽

pp. 399-401 ◽

Cited By ~ 16

Author(s):

J.H. Adams ◽

D. Doyle ◽

I. Ford ◽

D.I. Graham ◽

M. McGee ◽

...

Keyword(s):

Head Injury ◽

Brain Damage ◽

Traffic Accidents ◽

Road Traffic ◽

Head Injuries ◽

Diffuse Axonal Injury ◽

Diffuse Brain Swelling ◽

Type Of Injury ◽

The Relationship ◽

Diffuse Brain

Brain damage in a series of 635 fatal non-missile head injuries has been analysed with particular reference to the age of the patient and the type of injury. The differences in the type of brain damage in relation to age were less than we had anticipated, lending further support to the contention that the aged brain has a reduced potential for recovery. The analysis confirms the relationship between road traffic accidents, diffuse axonal injury, gliding contusions and ‘basal ganglia’ haematomas, and the importance of diffuse brain swelling resulting from a head injury in children.

Download Full-text

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

Journal of Biomechanics ◽

10.1016/s0021-9290(00)00135-4 ◽

2001 ◽

Vol 34 (1) ◽

pp. 85-94 ◽

Cited By ~ 45

Author(s):

D.R.S. Bradshaw ◽

J. Ivarsson ◽

C.L. Morfey ◽

D.C. Viano

Keyword(s):

Subdural Hematoma ◽

Axonal Injury ◽

Diffuse Axonal Injury ◽

Head Impact ◽

Acute Subdural Hematoma

Download Full-text

Cleft cavum of the septum pellucidum in victims of fatal road traffic accidents: a distinct type of cavum associated with severe diffuse axonal injury

Surgical Neurology ◽

10.1016/j.surneu.2004.09.012 ◽

2005 ◽

Vol 63 ◽

pp. S30-S35 ◽

Cited By ~ 7

Author(s):

José Eymard Homem Pittella ◽

Sebastião Gusmão

Keyword(s):

Traffic Accidents ◽

Road Traffic ◽

Axonal Injury ◽

Diffuse Axonal Injury ◽

Distinct Type ◽

Septum Pellucidum ◽

Road Traffic Accidents

Download Full-text

Bilateral traumatic basal ganglia haemorrhage, a rare entity

Romanian Neurosurgery ◽

10.33962/roneuro-2019-052 ◽

2019 ◽

pp. 310-315

Author(s):

Vibhu Shankar Parashar ◽

Vivek Kumar Kankane ◽

Gaurav Jaiswal ◽

Tarun Kumar Gupta

Keyword(s):

Basal Ganglia ◽

Head Injury ◽

World Literature ◽

Traffic Accidents ◽

Road Traffic ◽

Case Reports ◽

Diffuse Axonal Injury ◽

Closed Head Injury ◽

Rare Entity ◽

History Of

Aims. Traumatic basal ganglia haemorrhage is rare entity but post traumatic bilateral basal ganglia hematoma is even extremely rare and was earlier presented as case reports. Its incidence is about 3% after a closed head injury however, the incidence is higher in post mortem studies. Material & Methods. Out of 1485 head injury patients admitted to our institute from January 2012 to January 2019, there were 9 cases of traumatic bilateral basal ganglia haemorrhage. The incidence of traumatic bilateral basal ganglia Haemorrhage in our series is 0.61% which is very less compared to previous literature. Results. There were 6 males and 3 females; age ranging from 19 to 50 years (average 32 years). Patients with hypertension, history of drugs abuse, history of coagulopathy, with doubtful history of trauma or unknown mode of injury were excluded from the study. The mode of injury in all the patients was road traffic accidents. Average follow up was 9.54 months. Outcome was assessed by Glasgow outcome Score. In 8 out of 9 patients, outcome was good. One patient died. All the nine cases were managed conservatively. Conclusion. We report nine cases from a single institute which to the best of our knowledge is the largest series in world literature. Prognosis is variable and dependent on many factors. The prognosis of TBGH is favourable if not associated with other disorders like hypertension, diabetes mellitus, and coagulation disorders or diffuse axonal injury.

Download Full-text