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Diffuse axonal injury after severe head trauma. A clinico-pathological study
J Sahuquillo1, J Vilalta, J Lamarca
1Department of Neurosurgery, Vall d'Hebron Hospital, Autonomous University of Barcelona, School of Medicine, Spain.
Acta Neurochirurgica
|January 1, 1989
Summary
Diffuse Axonal Injury (DAI), a common finding in severe head trauma, occurs with or without visible mass lesions on CT scans. Postmortem examinations confirmed DAI in patients with immediate coma following trauma.
Area of Science:
- Neuropathology
- Trauma Medicine
- Forensic Pathology
Background:
- Diffuse Axonal Injury (DAI) is a critical consequence of severe head trauma.
- It is often associated with immediate coma and negative CT scans for mass lesions.
- DAI results from high-magnitude shear and tensile strains, typically from rotational acceleration.
Purpose of the Study:
- To present findings on DAI in a cohort of severe head injury patients.
- To analyze the occurrence of DAI with and without CT-evident mass lesions.
- To describe the pathological characteristics of DAI.
Main Methods:
- Postmortem examination of 24 severe head injury patients.
- Histological analysis focusing on axonal retraction balls.
- Categorization into subgroups based on CT scan findings (mass lesions vs. no mass lesions).
Main Results:
- Unequivocal signs of DAI were found in all 24 patients.
- Widespread axonal retraction balls were the predominant histological finding, especially in the centrum semiovale and internal capsule.
- DAI was present in 15 patients with no CT mass lesions and in 9 patients with associated mass lesions (hematomas).
Conclusions:
- Diffuse brain damage, including DAI, is common in severe head injuries with immediate coma, even without CT mass lesions.
- DAI can co-exist with various focal lesions such as subdural or intracerebral hematomas.
- Rotational acceleration mechanisms are strongly implicated in DAI development.