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- Title
A RADIOGRAPHIC ANATOMY AND ANATOMIC PATHOLOGY OF BRAIN INJURIES CAUSED BY SEVERE BRAIN TRAUMAS LEADING TO DEATH.
- Authors
Teodorescu, C. V.; Indrei, Anca; Dumitrescu, Gabriela Florenţa; Cianga, Corina; Haba, Danisia
- Abstract
A radiographic anatomy and anatomic pathology of brain injuries caused by severe brain traumas leading to death (Abstract): The purpose of this study is to investigate the possible correlations between the CT scan and microscopic aspects of SDH in order to identify the progressive model of the histological and morphological aspects met in SDH cases caused by severe brain skull traumas. Materials and method: This study included 38 adult patients (26 men and 12 women/ aged 18-67) who had been admitted, between January 1st, 2008 and December 31st, 2009 to the Neurosurgery Clinics of ?Prof. Dr. N. Oblu? Emergency Clinical Hospital of Iasi with symptomatic subdural hematoma (SDH), and with medical history of severe skull brain trauma. All patients had been treated by craniectomy with tissue samples from the hematoma wall and content, fragments subsequently submitted to the Anatomic Pathology Laboratory for histopathological and immunohistochemical examination in order to establish a potential correlation between the histopathological aspects and the posttraumatic interval. These morphological aspects included: erythrocytes, polymorphonuclear leucocytes, hemosiderin-laden macrophages, fibroblasts, endothelial cells, collagen fibres and the neo-membrane formation. The macrophagic reactivity associated to dura mater and the subjacent hematoma was determined using the immunohistochemical techniques with anti - CD68 antibodies. Results: The subdural hematomas studied have been classified in three groups depending on the time elapsed between the injury and the CT scanning: acute (< 7 days) - 5 cases, sub-acute (8 - 22 days) ? 23 cases and chronic (> 22 days) ? 10 cases. The CT density of SDH was also divided into 3 categories: hyperdense (1st group), isodense (2nd group) and hypodense (3rd group). The SDH density was measured directly on the CT image. The correlations between the time elapsed between the injury and the CT and the SDH aspect in the CT image showed that most of acute HSD (98.6%) are hyperdense, the sub-acute were either CT isodense (42.9%), or associated with tomographic hypodensity (45.7%), and most of the chronic ones (86.7%) associated with isodense CT aspects. From the microscopic viewpoint, acute subdural hematomas are characterized by the gradual formation of fibroblasts and siderophages at the level of hemorrhagic collection. After three weeks from the injury, the subdural hemorrhagic collection is being replaced by a conjunctive-vascular tissue, subsequently followed by the formation of a new fibrous membrane, sometimes accompanied by re-bleeding. In comparison with SDH neomembranes, the immunohistochemical investigations highlight different aspects of the positive CD 68 macrophages at the level of dura mater. Conclusions: 1. CT scanning detects various patterns generated by several factors including: the age of hematoma, the re-bleeding and the status of the patient?s hematocrit. 2. The SDH age can can be determined through histopathological examination of subdural membranes, but, despite the useful information on the SDH?s age provided by the histological examination, this cannot be determined accurately. The best answer is given in terms of time variations. 3. The method involving the association of morphological aspects detected through standard staining procedures with the expression of CD68 antigens on SDH macrophages following severe craniocerebral traumas is more appropriate to estimate the post-injury time and it allows a more accurate SDH dating together with the imaging aspects, this being useful information in the forensics practice. 4. The CT scan and histopathological characteristics varied from one individual to another, and thus they should be carefully construed, not rigidly.
- Subjects
BRAIN injuries; EMOTIONAL trauma; DIAGNOSTIC imaging; PREVENTIVE medicine; IMMUNOGLOBULINS; INFLAMMATION; PATHOLOGY
- Publication
Romanian Journal of Functional & Clinical, Macro & Microscopical Anatomy & of Anthropology / Revista Româna de Anatomie Functionala si Clinica, Macro si Microscopica si de Antropologie, 2011, Vol 10, Issue 1, p31
- ISSN
1583-4026
- Publication type
Article