The forensic neuropathology of blunt force trauma of the brain part 1 an introduction
This presentation is the property of its rightful owner.
Sponsored Links
1 / 11

THE FORENSIC NEUROPATHOLOGY OF BLUNT FORCE TRAUMA OF THE BRAIN Part 1: An Introduction PowerPoint PPT Presentation


  • 71 Views
  • Uploaded on
  • Presentation posted in: General

THE FORENSIC NEUROPATHOLOGY OF BLUNT FORCE TRAUMA OF THE BRAIN Part 1: An Introduction. Bennet I. Omalu, M.D., M.P.H. Forensic Pathologist/ Neuropathologist. SYNONYMS. Brain Trauma Neuro-trauma Traumatic Brain Injury [TBI] Cranio-Cerebral Injury Blunt Force Trauma of the Head

Download Presentation

THE FORENSIC NEUROPATHOLOGY OF BLUNT FORCE TRAUMA OF THE BRAIN Part 1: An Introduction

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


The forensic neuropathology of blunt force trauma of the brain part 1 an introduction

THE FORENSIC NEUROPATHOLOGY OF BLUNT FORCE TRAUMA OF THE BRAIN Part 1: An Introduction

Bennet I. Omalu, M.D., M.P.H.

Forensic Pathologist/ Neuropathologist


Synonyms

SYNONYMS

  • Brain Trauma

  • Neuro-trauma

  • Traumatic Brain Injury [TBI]

  • Cranio-Cerebral Injury

  • Blunt Force Trauma of the Head

  • TBI causes 44% of traumatic deaths in the US

    Blunt force trauma of the brain can be induced by

    transference of Kinetic Energy [KE] to the brain by

    an un-yielding object or surface with a relatively

    broad surface area like a base ball bat or a floor


Other common modalities of brain trauma

OTHER COMMON MODALITIES OF BRAIN TRAUMA

  • Penetrating Force Trauma of the Head

    • E.g.: Stab or incised wounds

  • Gunshot/ Firearm Wounds of the Head

    • E.g.: Hand-guns, rifles, shot-guns etc

  • Asphyxiation [Diffuse Hypoxic-Ischemic Cerebral Injury]

    • E.g.: Hanging, smothering, Carbon Monoxide intoxication etc

  • Toxic Injuries e.g. mercury, arsenic, methotrexate

  • Blunt Force Trauma of the Head is the most prevalent cause of brain injuries


Bio mechanical loading bml

BIO-MECHANICAL LOADING [BML]

  • Mechanism of transference of K.E. to the brain; three major types:

    • Impact Bio-Mechanical Loading

      • Transference of energy by direct impact of the head

        • E.g.: a fall from a height and impact of the head on a floor

        • E.g.: a base ball bat hitting the head in an assault

    • Inertial Bio-Mechanical Loading

      • Transference of energy to the head by acceleration-deceleration shearing forces without impact

        • E.g.: when a baby is shaken excessively

        • E.g.: sudden jerk of the head in the elderly without impact

    • Combined Impact-Inertial Bio-Mechanical Loading


Bio mechanical loading bml1

BIO-MECHANICAL LOADING [BML]

  • Angular or rotational acceleration-deceleration is more deleterious to the brain than linear acceleration-deceleration

  • There is a selective topographic vulnerability of the brain to modalities of bio-mechanical loading

    • E.g.: the splenium of the corpus callosum is most vulnerable to diffuse shearing of the brain

  • Impact BML is more likely to generate focal traumatic brain injury

  • Inertial BML is more likely to generate diffuse traumatic brain injury


Definitions

DEFINITIONS

  • Primary Brain Injury

    Direct and immediate consequence of trauma to the brain e.g. cerebral contusion

  • Secondary Brain Injury

    Indirect and delayed consequence of trauma to the brain e.g. cerebral edema, cerebral herniation

  • Closed Head Injury

    Brain injury with intact dura mater

  • Open Head Injury

    Brain injury with lacerated or disrupted dura mater

    Major complications: Streptococcal meningitis and

    dural fistula


Definitions1

DEFINITIONS

  • Focal Traumatic Brain Injury

    Localized injury of the brain e.g. lobar cerebral

    contusion, subdural hemorrhage

  • Diffuse Traumatic Brain Injury

    Generalized injury to all regions of the brain e.g.

    diffuse shearing of the brain: Diffuse Traumatic

    Axonal Injury, Diffuse Hypoxic Injury

  • Brain Injury Grading: Glasgow Coma Scale

    Within 48 hours:

    Severe TBI: GCS 1–8

    Moderate TBI: GCS 9–12

    Mild TBI: GCS 13-15


Glasgow coma scale

GLASGOW COMA SCALE

Best Eye Response. (4)

1. No eye opening.

2. Eye opening to pain.

3. Eye opening to verbal command.

4. Eyes open spontaneously

Best Verbal Response. (5)

1. No verbal response

2. Incomprehensible sounds.

3. Inappropriate words.

4. Confused

5. Orientated

  • Best Motor Response. (6)

    • 1. No motor response.

    • 2. Extension to pain.

    • 3. Flexion to pain.

    • 4. Withdrawal from pain.

    • 5. Localising pain.

    • 6. Obeys Commands.

A minimum score of 3

A maximum score of 15

Teasdale G., Jennett B., LANCET (ii) 81-83, 1974.


Mild traumatic brain injury

MILD TRAUMATIC BRAIN INJURY

Physiological disruption of brain function due to trauma, as manifested by at least one of the following: 1. Any period of loss of consciousness 2. Any loss of memory for events immediately before or after the trauma 3. Any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused) 4. Focal neurological deficit(s) that may or may not be transient

But where the severity of the injury does not exceed the

following: a. Post-traumatic amnesia (PTA) not greater than 24 hours

b. After 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15

c. Loss of consciousness of approximately 30 minutes or less


Manifestations of bft of the head

MANIFESTATIONS OF BFT OF THE HEAD

  • Abrasions/ Contusions/ Lacerations of Scalp

  • Galeal Hemorrhages

  • Fractures of the skull

  • Intra-cranial hemorrhages

  • Cerebral contusions/ lacerations

  • Congestive brain swelling and cerebral edema

  • Hypoxic-ischemic brain injury

  • Traumatic axonal injury

  • Diffuse vascular injury

  • Cerebral fat embolism


The forensic neuropathology of blunt force trauma of the brain part 1 an introduction

EPIDEMIOLOGY

  • 500,000 - 750,000 cases of CNS trauma per year in the U.S.

    • 10% are fatal

    • 30 - 50% are moderate/ severe

    • 5 - 10% result in residual deficits

  • 150/100,000 population have sequelae of CNS trauma

  • Leading cause of death in people under 45 years of age

  • Accounts for 1% of all deaths

  • Accounts for 30% of deaths from trauma

  • Accounts for 50% of deaths due to road traffic accidents


  • Login