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Head Injury in Routine and Forensic Pathological Practice

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Neuropathology

Part of the book series: Current Topics in Pathology ((CT PATHOLOGY,volume 95))

Abstract

In recent years, head injury has lost its Cinderella status in the neuroscience world, as advances in the understanding of the cellular pathology have opened up the very real possibility of therapeutic intervention. For pathologists, a direct consequence of this has been that not only can much more of the tissue damage resulting from trauma now be appreciated on light microscopy, thanks to the development of immunocytochemical markers, but also there are often greater expectations of the autopsy and brain examination in a head injury case. This chapter describes a modern approach to head injury for non-neuropathologists, then addresses the specific problem of axonal injury, and finally tackles a rather specialist subject about which there is very little published information — namely, non-accidental head injury in infants.

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References

  1. Abou-Hamden A, Blumbergs PC, Scott G, Manavis J, Wainwright H, Jones N, McLean J (1997) Axonal injury in falls. J Neurotrauma 14: 699–713

    Article  PubMed  CAS  Google Scholar 

  2. Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR (1989) Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 15: 49–59

    Article  PubMed  CAS  Google Scholar 

  3. Adams JH, Doyle D, Graham DI, Lawrence AE, McLellan DR (1984) Diffuse axonal injury in head injuries caused by a fall. Lancet 2: 1420–1422

    Article  PubMed  CAS  Google Scholar 

  4. Adams JH, Doyle D, Graham DI, Lawrence AE, McLellan DR (1985) Microscopic diffuse axonal injury in cases of head injury. Med Sci Law 25: 265–269

    PubMed  CAS  Google Scholar 

  5. Adams JH, Graham DI, Gennarelli TA, Maxwell WL (1991) Diffuse axonal injury in non-missile head injury. J Neurol Neurosurg Psychiatry 54:481–483

    Article  PubMed  CAS  Google Scholar 

  6. Adams JH, Jennett B, McLellan DR, Murray LS, Graham DI (1999) The neuropathology of the vegetative state after head injury. J Clin Pathol 52: 804–806

    Article  PubMed  CAS  Google Scholar 

  7. Barozzino T, Sgro M, Toi A, Akouri H, Wilson S, Yeo E, Blaser S, Chitayat D (1998) Fetal bilateral subdural haemorrhages. Prenatal diagnosis and spontaneous resolution by time of delivery. Prenat Diagn 18:496–503

    Article  PubMed  CAS  Google Scholar 

  8. Blumbergs PC, Scott G, Manavis J, Wainwright H, Simpson DA, McLean AJ (1994) Staining of amyloid precursor protein to study axonal damage in mild head injury. Lancet 344: 1055–1056

    Article  PubMed  CAS  Google Scholar 

  9. Blumbergs PC, Scott G, Manavis J, Wainwright H, Simpson DA, McLean AJ (1995) Topography of axonal injury as defined by amyloid precursor protein and the sector scoring method in mild and severe closed head injury. J Neurotrauma 12: 565–572

    Article  PubMed  CAS  Google Scholar 

  10. Bromilow A, Burns J (1985) Technique for removal of the vertebral arteries. J Clin Pathol 38: 1400–1402

    Article  PubMed  CAS  Google Scholar 

  11. Brown JK, Minns RA (1993) Non-accidental head injury, with particular reference to whiplash shaking injury and medico-legal aspects. Dev Med Child Neurol 35: 849–869

    Article  PubMed  CAS  Google Scholar 

  12. Calder IM, Hill I, Scholtz CL (1984) Primary brain trauma in non-accidental injury. J Clin Pathol 37: 1095–1100

    Article  PubMed  CAS  Google Scholar 

  13. David TJ (1999) Shaken baby (shaken impact) syndrome: non-accidental head injury in infancy J Roy Soc Med 92: 556–561

    PubMed  CAS  Google Scholar 

  14. De Caro R, Munari PF, Parenti A (1998) Middle cerebral artery thrombosis following blunt head trauma. Clin Neuropathol 17: 1–5

    PubMed  Google Scholar 

  15. De Stefano N, Matthews PM, Fu L, Narayanan S, Stanley J, Francis GS, Antel JP, Arnold DL (1998) Axonal damage correlates with disability in patients with relapsing-remitting multiple sclerosis. Results of a longitudinal magnetic resonance spectroscopy study. Brain 121: 1469–1477

    Article  PubMed  Google Scholar 

  16. Deck JH, Jagadha V (1986) Fatal subarachnoid hemorrhage due to traumatic rupture of the vertebral artery. Arch Pathol Lab Med 110:489–493

    PubMed  CAS  Google Scholar 

  17. Dekaban AS, Sadowsky D (1978) Changes in brain weights during the span of human life: relation of brain weights to body heights and body weights. Ann Neurol 4: 345–356

    Article  PubMed  CAS  Google Scholar 

  18. Duhaime AC, Alario AJ, Lewander WJ, Schut L, Sutton LN, Seidl TS, Nudelman S, Budenz D, Hertle R, Tsiaras W et al. (1992) Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 90: 179–185

    PubMed  CAS  Google Scholar 

  19. Duhaime AC, Christian CW, Rorke LB, Zimmerman RA (1998) Nonaccidental head injury in infants—the “shaken-baby syndrome”. N Engl J Med 338: 1822–1829

    Article  PubMed  CAS  Google Scholar 

  20. Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R (1987) The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 66:409–415

    Article  PubMed  CAS  Google Scholar 

  21. Ehrenforth S, Klarmann D, Zabel B, Scharrer I, Kreuz W (1998) Severe factor V deficiency presenting as subdural haematoma in the newborn [letter]. Eur J Pediatr 157: 1032

    Article  PubMed  CAS  Google Scholar 

  22. Feldman KW, Weinberger E, Milstein JM, Fligner CL (1997) Cervical spine MRI in abused infants. Child Abuse Negl 21: 199–205

    Article  PubMed  CAS  Google Scholar 

  23. Ferguson B, Matyszak MK, Esiri MM, Perry VH (1997) Axonal damage in acute multiple sclerosis lesions. Brain 120: 393–399

    Article  PubMed  Google Scholar 

  24. Garcia JH, Anderson M (1997) Circulatory disorders and their effects on the brain. In: Davis RL, Robertson DM (eds) Textbook of neuropathology. Williams and Wilkins, Baltimore, pp 715–822

    Google Scholar 

  25. Gean AD (1994) Imaging of Head Trauma. Raven Press, New York

    Google Scholar 

  26. Geddes JF, Gonzalez AG (1991) Examination of spinal cord in diseases of the craniocervical junction and high cervical spine. J Clin Pathol 44: 170–172

    Article  PubMed  CAS  Google Scholar 

  27. Geddes JF, Vowles GH, Beer TW, Ellison DW (1997) The diagnosis of diffuse axonal injury: implications for forensic practice. Neuropathol Appl Neurobiol 23: 339–347

    Article  PubMed  CAS  Google Scholar 

  28. Geddes JF, Whitwell HL, Graham DI (2000) Traumatic axonal injury: practical issues for diagnosis in medicolegal cases. Neuropathol Appl Neurobiol 26: 105–116

    Article  PubMed  CAS  Google Scholar 

  29. Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL (2001) Neuropathology of inflicted head injury in children. 1: Patterns of brain damage. Brain (in press)

    Google Scholar 

  30. Geddes JF, Vowles GH, Hackshaw AK, Nickols CD, Scott IS, Whitwell HL (2001) Neuropathology of inflicted head injury in children. 2: Microscopic brain injury in infants. Brain (in press)

    Google Scholar 

  31. Gehrmann J, Banati RB, Cuzner ML, Kreutzberg GW, Newcombe J (1995) Amyloid precursor protein (APP) expression in multiple sclerosis lesions. Glia 15: 141–151

    Article  PubMed  CAS  Google Scholar 

  32. Gennarelli TA, Thibault LE, Graham DI (1998) Diffuse axonal injury: an important form of traumatic brain damage. Neuroscientist 4:202–215

    Article  Google Scholar 

  33. Gentleman SM, Nash MJ, Sweeting CJ, Graham DI, Roberts GW (1993) Beta-amyloid precursor protein (beta APP) as a marker for axonal injury after head injury. Neurosci Lett 160: 139–144

    Article  PubMed  CAS  Google Scholar 

  34. Gentleman SM, Roberts GW, Gennarelli TA, Maxwell WL, Adams JH, Kerr S, Graham DI (1995) Axonal injury: a universal consequence of fatal closed head injury? Acta Neuropathol 89: 537–543

    Article  PubMed  CAS  Google Scholar 

  35. Giometto B, An SF, Groves M, Scaravilli T, Geddes JF, Miller R, Tavolato B, Beckett AA, Scaravilli F (1997) Accumulation of beta-amyloid precursor protein in HIV encephalitis: relationship with neuropsychological abnormalities. Ann Neurol 42: 34–40

    Article  PubMed  CAS  Google Scholar 

  36. Gleckman AM, Bell MD, Evans RJ, Smith TW (1999) Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining. Arch Pathol Lab Med 123: 146–151

    PubMed  CAS  Google Scholar 

  37. Graham DI, Gennarelli TA (1996) Trauma. In: Graham DI, Lantos PL (eds) Greenfield’s neuropathology. 1. Arnold, London, pp 197–262

    Google Scholar 

  38. Graham DI, Lawrence AE, Adams JH, Doyle D, McLellan D, Gennarelli TA (1989) Pathology of mild head injury. In: Hoff JT, Anderson T, Cole T (eds) Mild to moderate head injury. Blackwell Scientific, Boston, pp 63–75

    Google Scholar 

  39. Graham DI, McLellan D, Adams JH, Doyle D, Kerr A, Murray LS (1983) The neuropathology of the vegetative state and severe disability after non-missile head injury. Acta Neurochir Supp 32: 65–67

    CAS  Google Scholar 

  40. Green PM, Wilson H, Romaniuk C, May P, Welch CR (1999) Idiopathic intracranial haemorrhage in the fetus. Fetal Diagn Ther 14: 275–278

    Article  PubMed  CAS  Google Scholar 

  41. Hadley MN, Sonntag VK, Rekate HL, Murphy A (1989) The infant whiplash-shake injury syndrome: a clinical and pathological study. Neurosurgery 24: 536–540

    Article  PubMed  CAS  Google Scholar 

  42. Hardman JM (1979) The pathology of traumatic brain injuries. In: Thompson RA, Green JR (eds) Complications of nervous system Trauma. Adv Neurol 22. Raven Press, New York, pp 15–50

    Google Scholar 

  43. Hardman JM (1997) Cerebrospinal trauma. In: Davis RL, Robertson DM (eds) Textbook of neuropathology. Williams & Wilkins, Baltimore, pp 1199

    Google Scholar 

  44. Harland WA, Pitts JF, Watson AA (1983) Subarachnoid haemorrhage due to upper cervical trauma. J Clin Pathol 36: 1335–1341

    Article  PubMed  CAS  Google Scholar 

  45. Hart BL, Dudley MH, Zumwalt RE (1996) Postmortem cranial MRI and autopsy correlation in suspected child abuse. Am J Forensic Med Pathol 17:217–224

    Article  PubMed  CAS  Google Scholar 

  46. Jafari SS, Nielson M, Graham DI, Maxwell WL (1998) Axonal cytoskeletal changes after nondisruptive axonal injury. II. Intermediate sized axons. J Neurotrauma 15:955–966

    Article  PubMed  CAS  Google Scholar 

  47. Jaspan T, Narborough G, Punt JA, Lowe J (1992) Cerebral contusional tears as a marker of child abuse-detection by cranial sonography. Pediatr Radiol 22:237–245

    Article  PubMed  CAS  Google Scholar 

  48. Johnson DL, Boal D, Baule R (1995) Role of apnea in nonaccidental head injury. Pediatr Neurosurg 23:305–310

    Article  PubMed  CAS  Google Scholar 

  49. Kinney HC, Samuels MA (1994) Neuropathology of the persistent vegetative state. A review. J Neuropathol Exp Neurol 53:548–558

    Article  PubMed  CAS  Google Scholar 

  50. Knight B (1989) The autopsy in the non-accidental injury syndrome. In: Mason JK (ed) Paediatric forensic medicine and pathology. Chapman & Hall Medical, London, pp 269–287

    Google Scholar 

  51. Koszyca B, Blumbergs PC, Manavis J, Wainwright H, James R, Gilbert J, Jones N, Reilly PL (1998) Widespread axonal injury in gunshot wounds to the head using amyloid precursor protein as a marker. J Neurotrauma 15:675–683

    Article  PubMed  CAS  Google Scholar 

  52. Lafont M, Lamarque M, Daussac E (1999) [Favorable outcome of a subdural hematoma diagnosed in utero]. Arch Pediatr 6:962–965

    Article  PubMed  Google Scholar 

  53. Leetsma J (1995) Forensic neuropathology. In: Duckett S (ed) Pediatric neuropathology. Williams & Wilkins, Baltimore, pp 243–283

    Google Scholar 

  54. Leetsma JE (1988) Neuropathology of child abuse. In: Forensic neuropathology. Raven Press, New York, pp 333–356

    Google Scholar 

  55. Leetsma JE (1997) Forensic neuropathology. In: Garcia JH (ed) neuropathology: The Diagnostic Approach. Mosby, St Louis, pp 518

    Google Scholar 

  56. Lindenberg R, Freytag E (1969) Morphology of brain lesions from blunt trauma in early infancy. Arch Pathol 87: 298–305

    PubMed  CAS  Google Scholar 

  57. Lindenberg R, Freytag E (1970) Brainstem lesions characteristic of traumatic hyperextension of the head. Arch Pathol 90: 509–515

    PubMed  CAS  Google Scholar 

  58. Liu HY, Huang LT, Lui CC (1998) Vacuum extraction delivery complicated with acute subdural hematoma and cerebral infarction: report of one case. Chung-Hua Min Kuo Hsiao Erh Ko i Hsueh Hui Tsa Chih 39: 119–122

    PubMed  CAS  Google Scholar 

  59. Maxwell WL, Islam MN, Graham DI, Gennarelli TA (1994) A qualitative and quantitative analysis of the response of the retinal ganglion cell soma after stretch injury to the adult guinea-pig optic nerve. J Neurocytol 23: 379–392

    Article  PubMed  CAS  Google Scholar 

  60. Maxwell WL, Povlishock JT, Graham DI (1997) A mechanistic analysis of nondisruptive axonal injury: a review. J Neurotrauma 14:419–440

    Article  PubMed  CAS  Google Scholar 

  61. McKenzie KJ, McLellan DR, Gentleman SM, Maxwell WL, Gennarelli TA, Graham DI (1996) Is beta-APP a marker of axonal damage in short-surviving head injury? Acta Neuropathol 92:608–613

    Article  PubMed  CAS  Google Scholar 

  62. McLellan DR, Adams JH, Graham DI, Kerr AE, Teasdale GM (1986) The structural basis of the vegetative state and prolonged coma after non-missile head injury. In: Papo I, Cohadon F, Massarotti M (eds) Le coma traumatique. Liviana Editrice, Padova, pp 165–185

    Google Scholar 

  63. Meyerhoff DJ, MacKay S, Constans JM, Norman D, Van Dyke C, Fein G, Weiner MW (1994) Axonal injury and membrane alterations in Alzheimer’s disease suggested by in vivo proton magnetic resonance spectroscopic imaging. Ann Neurol 36:40–47

    Article  PubMed  CAS  Google Scholar 

  64. Munro D, Merritt HH (1936) Surgical pathology of subdural hematoma. Arch Neurol Psychiatry 35:64–78

    Google Scholar 

  65. Ng HK, Mahaliyana RD, Poon WS (1994) The pathological spectrum of diffuse axonal injury in blunt head trauma: assessment with axon and myelin strains. Clin Neurol Neurosurg 96: 24–31

    Article  PubMed  CAS  Google Scholar 

  66. Ng PC, Fok TF, Lee CH, Wong W, Cheung KL (1998) Massive subdural haematoma: an unusual complication of septicaemia in preterm very low birthweight infants. J Pediatr Child Health 34: 296–298

    Article  CAS  Google Scholar 

  67. Opeskin K, Burke MP (1998) Vertebral artery trauma. Am J Forensic Med Pathol 19: 206–217

    Article  PubMed  CAS  Google Scholar 

  68. Ophoven JJ (1997) Pediatric forensic pathology. In: Gilbert-Barness E (ed) Potter’s pathology of the fetus and infant. 2. Mosby, St Louis, pp 1582–1624

    Google Scholar 

  69. Ophthalmology Child Abuse Working Party (1999) Child abuse and the eye. Eye 13: 3–10

    Article  Google Scholar 

  70. Oppenheimer DR (1968) Microscopic lesions in the brain following head injury. J Neurol Neurosurg Psychiatry 31:299–306

    Article  PubMed  CAS  Google Scholar 

  71. Perrin RG, Rutka JT, Drake JM, Meltzer H, Hellman J, Jay V, Hoffman HJ, Humphreys RP (1997) Management and outcomes of posterior fossa subdural hematomas in neonates. Neurosurgery 40: 1190–1199; discussion 1199–1200

    Article  PubMed  CAS  Google Scholar 

  72. Pilz P (1983) Axonal injury in head injury. Acta Neurochir Suppl 32: 119–123

    CAS  Google Scholar 

  73. Renzulli P, Tuchschmid P, Eich G, Fanconi S, Schwobel MG (1998) Early vitamin K deficiency bleeding after maternal phenobarbital intake: management of massive intracranial haemorrhage by minimal surgical intervention. Eur J Pediatr 157:663–665

    Article  PubMed  CAS  Google Scholar 

  74. Riggs JE, Schochet SS (1995) Spastic quadriparesis, dysarthria, and dysphagia following cervical hyperextension: a traumatic pontomedullary syndrome. Milit Med 160: 94–95

    CAS  Google Scholar 

  75. Rogers CB, Itabashi HH, Tomiyasu U, Heuser ET (1998) Subdural neomembranes and sudden infant death syndrome. J Forensic Sci 43: 375–376

    PubMed  CAS  Google Scholar 

  76. Saternus K, Kernbach-Wighton G, Oehmichen M (2000) The shaking trauma in infants — kinetic chains. Forensic Sci Int 109: 203–213

    Article  PubMed  CAS  Google Scholar 

  77. Shannon P, Smith CR, Deck J, Ang LC, Ho M, Becker L (1998) Axonal injury and the neuropathology of shaken baby syndrome. Acta Neuropathol 95:625–631

    Article  PubMed  CAS  Google Scholar 

  78. Sherriff FE, Bridges LR, Sivaloganathan S (1994) Early detection of axonal injury after human head trauma using immunocytochemistry for beta-amyloid precursor protein. Acta Neuropathol 87: 55–62

    Article  PubMed  CAS  Google Scholar 

  79. Stys PK (1998) Anoxic and ischemic injury of myelinated axons in CNS white matter: from mechanistic concepts to therapeutics. J Cereb Blood Flow Metab 18: 2–25

    Article  PubMed  CAS  Google Scholar 

  80. Tatsuno Y, Lindenberg R (1974) Basal subarachnoid hematomas as sole intracranial traumatic lesions. Arch Pathol 97:211–215

    PubMed  CAS  Google Scholar 

  81. Tomei G, Spagnoli D, Ducati A, Landi A, Villani R, Fumagalli G, Sala C, Gennarelli TA (1990) Morphology and neurophysiology of focal axonal injury experimentally induced in the guinea pig optic nerve. Acta Neuropathol 80: 506–513

    Article  PubMed  CAS  Google Scholar 

  82. Vowles GH, Scholtz CL, Cameron JM (1987) Diffuse axonal injury in early infancy. J Clin Pathol 40: 185–189

    Article  PubMed  CAS  Google Scholar 

  83. Wilkinson AE, Bridges LR, Sivaloganathan S (1999) Correlation of survival time with size of axonal swellings in diffuse axonal injury. Acta Neuropathol 98: 197–202

    Article  PubMed  CAS  Google Scholar 

  84. Willis BK (1995) Vertebral and basilar artery injuries. In: Carter LP, Spetzler RF (eds) Neurovascular surgery. McGraw-Hill, New York, pp 1313–1336

    Google Scholar 

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Geddes, J.F., Whitwell, H.L. (2001). Head Injury in Routine and Forensic Pathological Practice. In: Love, S. (eds) Neuropathology. Current Topics in Pathology, vol 95. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59554-7_3

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  • DOI: https://doi.org/10.1007/978-3-642-59554-7_3

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