International Archives of Integrated Medicine, 1(1), September, 2014 Fatal craniocerebral injuries in victims who survi | Page 3

Fatal craniocerebral injuries in victims who survived for some period
24 hours and out of 25 cases of secondary
brainstem injury, 4 cases (16%) died within 24
hours.

Discussion
In the present study male victims, 47 cases
(94%) outnumbered female victims, 3 cases (6%)
with an approximate male-female ratio of 16:1.
female
Male dominance was also reported by various
authors [4, 5, 6, 7] and is attributed to the fact
that males are more mobile and frequently
involved in outdoor activities than females. Male
oor
preponderance was observed in all age groups,
most commonly affected age range being 21 to
50 years. Similar findings pertaining to age group
were also reported by Amit MP et al [2], Tyagi
al.
AK et al. [6] and Akang EEU et a [7]. RTA
al.
emerged as the single most common cause of
fatal head injury which was seen in 43 cases
(86%). Most of the victims were two wheeler
users or pedestrians in the age group of 20 plus
to 50 years. In this respect our findings were
consistent with the works of Kumar A et al [4],
al.
Amit MP et al. [2], Tyagi Ak et al. [6] and Johnson
.
MR et al. [8]. However, in the western countries
the majority of people injured in road traffic
accidents are car occupants [2, 9] It could be
9].
due to differences in comm
common mode of
transportation, two wheelers being more
popular conveyance in Chennai city and in fact in
India. In most of the circumstances the manner
of head injury was accidental in nature, 49 cases
(98%) and there was 1 case, 2% of assault. Most
of fall from height cases, 5 cases (10%), were
om
reported from construction site. Two young
patients were injured due to fall from the first
floor (20 feet height) while playing.
Gross hemorrhagic lesions were seen in 19
cases, out of which 6 cases (31.58%) were
associated with primary brainstem injury and 13
ciated
cases (68.42%) were associated with secondary
brainstem injury. Hemorrhagic contusions were

seen in midbrain in 6 cases (31.58%), Pons in 12
cases (63.16%) and medulla in one case (5.26%).
In cases of primary bra
brainstem injuries,
hemorrhagic lesions were seen in the dorsal and
dorsolateral aspect of the midbrain and the
dorsal aspect of upper Pons. In cases of
secondary brainstem injuries, hemorrhagic
lesions were found in the midline and
paramedian aspect of tegme
tegmentum of the
midbrain and the Pons. Present findings agreed
more or less with the works of Chattopadhyay S,
Tripathi C [10] and Ella FT [11]. In majority of
cases the direction of force was “Lateral”, i.e.
from side to side, seen in 36 cases (72%). The
unique observation during our present study is
ue
that those cases showing lateral impact also
sustained secondary brainstem injury due to
associated supratentorial traumatic mass with
the midline shift. The second most common
direction of force was from front to back, which
was seen in 11 cases (22%).
Skull bone fracture was seen in 26 cases (52%);
11 cases associated with primary brain stem
injury and 15 cases with secondary brain stem
injury. Temporal and parietal bones were the
common sites of fracture which was seen in 17
cases (34%). More or less similar observation
was also reported by Chattopadhyay S, Tripathi
C [10], Ghosh PK [12], Fimate L et al [13],
Salgado MSL, Colombage SM [14] and Yavuz M
et al. [15]. In case of skull base fracture,
involvement of the middle cranial fossa was the
he
maximum and similar observation was also
reported by Menon A et al [9] and Tirpude BH
[16]. Moreover, in majority of the fatal
.
cranicerebral injury cases, skull vault fractures
were found to be extended up to skull base. One
unique observation in the present study was the
higher incidence of “skull base fractures” with
the primary brainstem injury cases and the
“temporo-parietal skull fracture
parietal
fractures” with the
secondary brainstem injury cases. We did not
find any literature regarding this brain stem

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

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