International Archives of Integrated Medicine, 1(1), September, 2014 Fatal craniocerebral injuries in victims who survi | Página 2

Fatal craniocerebral injuries in victims who survived for some period
The present study was conducted in the
Institute of Forensic Medicine, Madras Medical
College, Chennai, Tamil Nadu (India). It is one of
the oldest and largest medical colleges and
tertiary multidisciplinary health care centre in
the country catering to a vast Chennai
metropolitan city and different parts of the
state. Because of heavy traffic congestion, the
speed is limited and in majority of the incidents
the anatomy of head is comparatively preserved
though it is fatally damaged. In our study we
study,
included only those cases having fatal head
injuries as defined by The Royal College of
Surgeons [3], U.K. Our main aim of the present
,
study is to analyze the autopsy findings of this
important regional injury in details and compare
our findings with the previous studies.

Material and method
We selected 50 cases of fatal head injury that
were admitted and died in our hospital. All these
cases were either admitted in Intensive Care
Unit or performed neurosurgery. Other brought
in dead cases of fatal head injuries or cases of
crushed head injuries were excluded from the
es
present study because in such cases brain
structure would be grossly damaged and
moreover we wanted to include the likely future
prognosis. After reflecting the scalp tissues, the
vault of the skull and meninges were dissected
to expose the brain by following the routine
autopsy techniques. Detail information such as
post mortem number, name, age, sex, date and
time of injury, mode of injury, site of impact and
other relevant data were noted. Other relevant
information was also collected from the hospital
lected
records,
police
papers
and
relatives.
Involvement of brain stem was confirmed with
n
histopathological examination and identified as
pathological
primary and secondary brain stem injuries.
These data were tabulated for easy study and
comparison with the previous available studies.
ith

Observation
These 50 cases of fatal craniocerebral injuries
comprised about 2.82% of all medico legal
autopsies conducted during the study period.
The incidence of brain stem involvement in fatal
craniocerebral injury cases was very high,
observed in 41 cases (82%). Amongst these 41
cases of brain stem injury, 16 cases (39.02%)
were primary brainstem injury and 25 cases
(60.98%) were secondary brainstem injury.
Majority of the victims were middle aged male
though the age range was wide spread from 4 –
e
87 years as per Table - 1.
Road Traffic Accidents (RTA) was the single most
common cause of fatal head injury which was
seen in 43 cases (86%) as shown in Table - 2.
ases
Homicidal head injury was observed only in one
case. The most common site for brain stem
hematoma was the Pons, seen in 12 case
cases
(63.16%) as shown in Table - 3.
The incidence was high with lateral i.e. side to
side force, 36 cases (72%) as shown in Table - 4.
ases
Skull bone fracture was encountered in 26 cases
(52%). The occipital bone was the least
commonly involved; seen in only one case (2%)
as shown in Table - 5. In primary brainstem
lesions gross hemorrhagic lesions were seen in
dorsal, dorsolateral aspect of midbrain and
dorsal aspect of upper Pons. In se
secondary
brainstem lesions gross hemorrhagic lesions
were seen in the midline and paramedian aspect
of tegmentum of midbrain and Pons.
In majority of the cases, death occurred within
24 hours of hospitalization. The mean survival
period was about 73.42 hours (range being 6
hours to 600 hours). The mean survival period of
the primary brainstem injury was 41.55 hours
and that of the secondary brainstem injury was
ry
103.2 hours. Out of 16 cases of primary
brainstem injury, 5 cases (31.25%) died within

International Archives of Integrated Medicine, Vol. 1, Issue. 1, September, 2014.
Copy right © 2014, IAIM, All Rights Reserved.

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