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. Page 3