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Evaluation of brain injuries in children deceased due to head trauma
Andreea Lavinia Zorilă1, Marian Valentin Zorilă, Marius Cristian Marinaş
1Department of Forensic Medicine, Department of Pathologic Physiology, University of Medicine and Pharmacy of Craiova, Romania; zorilavaly@yahoo.com.au, drcristianneamtu@yahoo.com.
Insights
Severe traumatic brain injuries (TBIs) in children, often caused by traffic accidents, result in complex cranial and brain damage. Injury severity escalates with survival time due to secondary ischemic and inflammatory lesions.
Area of Science:
- Neurology
- Forensic Pathology
- Pediatric Traumatology
Background:
- Traumatic brain injuries (TBIs) are increasingly prevalent, particularly in developing nations, leading to significant neurological deficits.
- While most TBIs are mild, severe cases in children, often from traffic accidents, pose a critical public health concern.
Purpose of the Study:
- To analyze the characteristics and outcomes of severe traumatic brain injuries in deceased children.
- To investigate the correlation between injury severity, survival time, and histopathological findings in pediatric TBIs.
Main Methods:
- Retrospective analysis of 29 severe TBI cases in children.
- Forensic examination to identify cranial fractures and meningo-cerebral injuries.
- Histopathological and immunohistochemical analysis to assess secondary lesions and inflammation.
Main Results:
- Traffic accidents caused over 68% of severe pediatric TBIs, with incidence peaking in the 10-15 age group.
- Complex injuries were prevalent: 86.21% had cranial fractures, and 93% exhibited severe meningo-cerebral damage including hemorrhage and brain contusions.
- Histopathology revealed increased injury severity with longer survival, marked by secondary ischemic and inflammatory changes.
Conclusions:
- Severe pediatric TBIs are frequently complex, often resulting from traffic accidents and characterized by significant cranial and brain damage.
- Survival time exacerbates TBI severity through secondary ischemic and inflammatory processes, highlighting the critical need for prompt and effective management.
Abstract:
Traumatic brain injuries (TBIs) present an ever-growing prevalence, especially in the developing countries. Although 80-95% are mild to average injuries, they determine multiple severe neurological sequelae and disabilities. Most of these injuries are caused by traffic accidents. We studied a number of 29 cases of severe TBIs, in children who deceased immediately or after a few days of survival. Most of them (over 68%) were caused by traffic accidents. The incidence of traumas increased by age, most cases being recorded in the age group 10-15 years old. The TBIs were complex ones. In 86.21% of the cases, the forensic examination highlighted the presence of cranial fractures; in 93% of the cases, there were highlighted complex meningo-cerebral injuries: leptomeningeal hemorrhage associated with brain contusion injuries and with intraventricular blood flood, as well as destructive lesions of brain dilaceration; only in 7% of the cases there were highlighted meningeal lesions, with no brain lesions. The severity of the brain injuries was quite varied, according to the force of the cause agent. The histopathological and immunohistochemical examinations showed that the severity of TBIs increased according to the survival time, by adding secondary lesions caused by brain ischemia and local inflammatory reaction.
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