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
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Bennet I. Omalu, M.D., M.P.H.
Forensic Pathologist/ Neuropathologist
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
Direct and immediate consequence of trauma to the brain e.g. cerebral contusion
Indirect and delayed consequence of trauma to the brain e.g. cerebral edema, cerebral herniation
Brain injury with intact dura mater
Brain injury with lacerated or disrupted dura mater
Major complications: Streptococcal meningitis and
Localized injury of the brain e.g. lobar cerebral
contusion, subdural hemorrhage
Generalized injury to all regions of the brain e.g.
diffuse shearing of the brain: Diffuse Traumatic
Axonal Injury, Diffuse Hypoxic Injury
Within 48 hours:
Severe TBI: GCS 1–8
Moderate TBI: GCS 9–12
Mild TBI: GCS 13-15
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.
A minimum score of 3
A maximum score of 15
Teasdale G., Jennett B., LANCET (ii) 81-83, 1974.
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