A quantitative method for comparing the distribution of cerebral trauma in closed-head injuries with and without...

Damage to the cerebral and cerebellar hemispheres and brain-stem was investigated in forty-seven cases of closed-head injury of which twenty-four had undergone tentorial herniation. The damage was assessed by eye in coronal sections as well as microscopically using celloidin and paraffin techniques. All cases had damage to the hemispheres and brain stem. The types and positions of the damage were plotted on charts and quantified by using a cm2 grid system. The quantity of the haemorrhage and ischaemia in the hemispheres was found by Student's t-test to be statistically greater (P less than 0.001) for cases which had herniated. Haemorrhage and ischaemia were most frequently seen on the ventral aspect of the hemispheres and particularly the frontal lobes. The distribution of the haemorrhage and ischaemia was the same for both the herniated and non-herniated brains. In a subsample of sixteen cases statistically significant differences were found using the X2 test for the positions of brain-stem damage per se in herniated and non-herniated brains. In a second subsample of thirty-two cases a statistical difference in the position of haemorrhage was also found. The greatest damage to the brain-stem was medial and rostral in herniated brains and paralateral and rostral but extending further caudally in non-herniated brains. The variation in quantity of the five types of damage with length of survival was compared for herniated and non-herniated brains.